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A 

TREATISE 



ON THE 



ANATOMY, PHYSIOLOGY AND DISEASES 



HUMAN EAR. 



BY JAMES BRYAN, M. D. 

PROFESSOR OF SURGERY, IN GENEVA MEDICAL COLLEGE ; PROFESSOR OF INSTITUTES OT MEDI- 
CINE AND MEDICAL JURISPRUDENCE, IN THE PHILADELPHIA COLLEGE OF MEDICINE; 
PRESIDENT OF THE MEDICO-CHIRURGICAL COLLEGE, OF PHILADELPHIA; CORRES- 
PONDING MEMBER OF THE NEW YORK MEDICAL AND SURGICAL SOCIETY; MEM 
PER OF THE AMERICAN MEDICAL ASSOCIATION, AND OF THE CONTENTION 
FOR THE REVISION OF THE UNITED STATES PHARMACOPOEIA, ETC. 



Sed in his [auribus] aliquanto majus periculum est. Nam vitia oculomm intra ip?os 
nocent; aurium inflammationes doloresque, interdum etiam ad dementiam mortemque 
precipitant. Quo niagis inter initia protinus succurrendum est, ne majori periculo 
locus sit. 

A. Corn : Celsi. Lib. VI. Cap. vii. 










PHILADELPHIA: 
PUBLISHED BY THE AUTHOR. 

1851. 



) 



Ml 









TO 

VALENTINE MOTT, M. D. 

WHOSE PRE-EMINENCE AMONG LIYING SURGEONS, IS UNIVERSALLY 
ACKNOWLEDGED, THIS MONOGRAPH IS RESPECTFULLY AND CORDIALLY 
DEDICATED, 

BY HIS FRIEND, 

THE AUTHOR. 



Entered according to Act of Congress, in the year 1851, by 

JAMES BRYAN, M. D., 

In the Clerk's office of the District Court of the United States, for the 
Eastern District of Pennsylvania. 






CONTENTS. 



BOOK I. 

ANATOMY, PHYSIOLOGY, AND COPHOSIS. 

CHAPTER I. page 

Anatomy of the Human Ear 9 

CHAPTER II. 
Physiology of the Ear 25 

CHAPTER III. 
Cophosis 32 



BOOK II. 

DISEASES OF THE EAR. 

CHAPTER I. 

Diseases of the Auricle . = = ...., 40 

(3) 



4 CONTENTS. 

CHAPTER II. pagb 

Diseases of the Meatus Auditorius Externus 46 

CHAPTER III. 
Diseases of the Membraxa Tympaxi 70 

CHAPER IV. 
Diseases of the Middle Ear 85 

CHAPTER V. 
Diseases of the Internal Ear 105 

CHAPTER VI. 
Deaf Mutes 119 

CHAPTER VII. 
Conclusion 122 



PREFACE. 



Having been in the habit for a number of years past, 
of delivering a course of lectures each year, to my pri- 
vate classes, on the subject of aural surgery : and having 
delivered a like course in the autumn of 1850, before the 
class attending the Philadelphia College of Medicine, the 
author resolved to embody the matter of those lectures in 
the following pages. 

The universally admitted dearth of American literature 
on this subject, was another pretty strong incentive to 
the rash act of printing and publishing a book on a new 
subject. 

In doing it, however, he will at least feel the satisfac- 
tion of ploughing in a comparative new field. The 
operative and theoretical surgery of our country will 
compare favorably, during the last half century, with that 
of Europe ; and it is hoped that, however imperfect the 
following little work may be in other respects, that it 
will exhibit all that is really valuable in American aural 
surgery, up to the present time. 

(5) 



6 PREFACE. 

It will be seen, that personal observation, (which has 
now extended over twenty years,) in his profession, has 
been relied on for many of the facts and principles in 
the treatment of aural diseases, — while the best authori- 
ties have been freely, though carefully quoted. 

The character of our people, like that of the Anglo- 
Saxons generally, is decidedly practical; the author has, 
therefore, avoided long dissertations, or theoretical specu- 
lations, on subjects purely speculative. Diseases whose 
existence has not been proved by post-obit or well attested 
clinical observations, are excluded. He has attempted to 
present as nearly as possible what is really known, and 
valuable, and avoided stating several operations which 
have not as yet received the sanction of the profession. 

The itch for publishing novelties has not to his know- 
ledge swayed the course of his pen or thoughts ; and he 
has preferred being a safe guide, to being more brilliant 
and striking, but less safe. 

If his endeavors meet with the approbation of the wise 
and good of his profession, and at the same time assist 
the junior practitioner to lessen the number of diseases 
arranged under the general head of the opprobria medi- 
corum y as well as relieve more satisfactorily those who 
suffer under these very common and difficult diseases, his 
object will be accomplished. He may add, in conclusion, 
to the profession, 

" Si quid novisti rectius istis 
Candid us imperti : si non, his utere mecum." 

Hor. 



INTRODUCTION. 



The limits of this work will not admit any thing like 
a proper historical sketch of aural surgery. We will, 
therefore, merely say in passing that very little has been 
added in modern times to the anatomy of the Ear. 

After the revival of literature, the discoveries of Eusta- 
chius, Scarpa and others leave us almost nothing to desire 
in reference to the Anatomy of this organ. 

This is not the case, however, with the pathology of 
the Ear. Of this the older surgeons knew comparatively 
nothing, as may be easily seen from the speculations pro- 
mulgated on this subject, with the varied and irregular 
treatment designed to cure diseases which existed only in 
the imaginations of the authors. 

To Kramer, of Berlin, is doubtless due the credit of 
directing attention to a more philosophic mode of investi- 
gating these hitherto obscure diseases. 

To Pilcher, that of a somewhat verbose exposition of 
what is considered by him, as known on the subject, and 
to Toynbee, Todd and other English and American 

(7) 



8 INTRODUCTION. 

writers is due what we really know of the changes which 
the delicate structure of this organ is subject to. Deleau's 
work is chiefly practical, but is encumbered by a number 
of contrivances and speculations, which make it rather 
unsafe for a practitioner to rely upon the dicta of this 
author. 



A TREATISE ON 

THE HUMAN EAR. 

BOOK L 
ANATOMY, PHYSIOLOGY, AND COPHOSIS. 

CHAPTEE I. 

ANATOMY OF THE HUMAN EAR. 

The usual anatomical division of this organ, is that which 
separates it into External, Middle, and Internal. 

The external embraces the auricle, which is divided into the 
lobus and pinna, together with the meatus auditorius externus, 
which extends from the auricle to the membrana tympani : the 
latter being sometimes arranged with the middle Ear. We 
will follow the latter arrangement. 

The whole organ is situated on and in the temporal bones on 
each side of the head — 

External Ear. — The soft portion which is pendulous from 
the pinna is termed the lobe of the Ear ; and is composed almost 
entirely of adipose tissue covered with the ordinary integument. 
It is not very sensitive, and after moderate pressure for a moment 
between the fingers, may be readily perforated with a knitting 
needle or perforator for the purpose of introducing a thread 

(9) 



10 THE HUMAN EAR. 

preparatory to wearing ornaments, or to keep up an irritation 
for the relief of sore eyes. 

Kg J. 




1. Pinna. — 2. Lobus. — 3. Helix. — 4. Anti-helix. — 5. Concha. 

All above the lobe is called the pinna, from its resemblance 
to a certain shell of that name. The outer scroll, commencing 
on the anterior margin and terminating posteriorly, and at the 
lobe, is called the helix. The next ridge on the outer surface 
of the ear, which commences forwards by two elevated lines and 
terminates below and posteriorly in the anti-tragus, is termed 
the anti-helix. The little space between the anterior double 
elevated lines of this ridge, is the scapha : while the general 
cavity which is surrounded by the anti-helix, and in whose 
centre we find the external orifice of the outer meatus, is the 
concha. 



ANATOMY OF THE HUMAN EAR. 11 

Anterior and out from the concha and meatus, we see a little 
cartilaginous projection which, from its having sometimes short 
rough hairs projecting from it, like those of a goat, is termed 
the tragus — and a similar projection posteriorly is the anti-tragus. 
The orifice of the external meatus is not unfrequently garnished 
with hairs, which may be long and bristling. The dorsal pro- 
jections and depressions of the auricle, correspond to the depres- 
sions and elevations of the ventral portion, and the whole auricle 
is attached to the margin of the hony meatus by ligamentous 
union — the cartilaginous portion extending into the canal from 
a quarter to half an inch. 

Three ligaments bind the auricle to the temporal bone — the 
anterior, superior, and posterior. 

Three muscles are also found connecting the auricle to the 
skull, which in some individuals are under the control of the 
will, and will move the ear in three several directions, viz : — 
upwards — the attollens auris — backwards — the retrahens auris 
— and forwards, the attrahens auris. 

The meatus auditorius externus is from an inch to an inch 
and a half long in the adult, and much shorter in the child and 
foetus. About midway it is moderately curved, (according to 
some at an angle of forty-five degrees,) forwards, inwards, and 
downwards, so that to straighten the passage, and thus bring the 
membrana tympani in the line of vision, it is necessary to draw 
the auricle upwards and backwards. This canal contains the 
following structures. — 1. Numerous short hairs at its entrance. 
— 2. Ceruminous follicles, which secrete a waxy matter soluble 
(according to Buchanan) in water. — 3. The ordinary integument 
of the ear modified. — 4. Areolar tissue which may be denomi- 
nated subcuticular. — 5. Periosteum. — 6. Bone and cartilage. 
The cartilaginous portion forms about half of the meatus, but 
does not make a complete tube, on account of its division into 
several distinct portions : these possess some motion on them- 



12 THE HUMAN EAR. 

selves. The upper and outer part is deficient in cartilage : its 
place being supplied by a dense fibrous structure. The bony 
part of the canal, to which the cartilaginous is attached, by 
condensed areolar tissue, is termed the processus auditivus 01 
the temporal bone. This, in the foetus, is a mere bony ring, 
and becomes more developed in after life. It is consequently 
deeper in old age than at any other period. 

In addition to the hairy development, which is found chiefly 
in the outer third of this tube, we have in the same locality, 
the above named ceruminous follicles — which secrete a thick, 
yellowish, viscid, inflammable, bitter substance : it contains 
oily fat, albumen, coloring matter and a peculiar animal matter. 
It is found to be offensive to insects, and probably preven 3 the 
passage from becoming too dry, a certain degree of moisture 
being necessary, not only to the healthy condition of the epi- 
dermoid tissue lining the canal, but to that of the membrana 
tympani itself. 

It is supposed by Eicherand, that the act of opening the 
mouth in listening attentively, has the effect to enlarge the 
meatus, and thus allow the entrance of an increased number ot 
sonorous vibrations. 

Middle Ear. The tympanum is a cavity found in the outer 
and posterior part of the petrous portion of the temporal bone, 
somewhat irregular in shape — rather the widest in its antero- 
posterior diameter, which is about half an inch in extent. The 
smallest width being transverse. It is bounded externally by 
the membrana tympani, internally by a thin osseous plate, which 
is perforated by two foramina, the fenestra ovalis, and the 
fenestra rotunda. An anterior canal, termed the Eustachian 
tube, communicates with the pharynx — and a posterior foramen 
with the mastoid cells. It is lined by a continuation of the 
mucous membrane of the pharynx, which also extends to the 
mastoid cells. 



ANATOMY OF THE HUMAN EAR, 

Fig. 2. 








EXTERNAL, MIDDLE, AND INTERNAL EAR. 

1. Auricle. — 2. Meatus Auditorius Extenms. — 3 Menibrana Tympani. — 4. Malleus. — 
5. Incus. — 6. Tympanum. — 7. Stapes. — 8. Semi-circular Canals. — 9. Portio Mollis 
(auditory nerve.) — 10. Cochlea. — 11. Eustachian tube. 

Membrana Tympani. A bony ring in the pars petrosa of 
the temporal bone, which forms the boundary between the 
auditory canal and the tympanum, gives attachment to the 
margin of this membrane. The latter is ovoid, the broader 
portion being above and backwards, while the narrower part 
is below, forward and downward. The outer surface forms 
with the floor of the auditory canal, an angle of about forty-five 
degrees — being inclined inwards and downwards. The outer 
surface is also convave a little below the centre, caused by the 
handle of the malleus drawing it inwards. Its color is a silvery 
brightness more or less, in a healthy state. Its structure accor- 
ding to Dr. Toynbee is as follows, 

1. The external epidermoid layer. 

2. The internal or mucous layer. 

3. The middle layer — which he says is composed of two 

2 



14 THE HUMAN EAR. 

classes of fibres. — 1. Cellular. — 2. Radiating. — He describes 
the lamina of radiating fibres, the outer surface of which is 
covered by the epidermis, as continuous with the periosteum 
of the external meatus, with the exception of the uppermost 
layers, which being somewhat flaccid, have been termed mem- 
brana flaccida. The radiating layer is composed of fibres which 
extend from the circular cartilaginous ring to the malleus, 
interlacing with each other. These fibres are from 4 to 5,000 
parts of an inch in diameter. The circular fibres are firm and 
strong towards the circumference, but very much attenuated 
towards the centre. The circular fibres are also smaller than 
the radiating, being from 6 to 10,900 parts of an inch in diame- 
ter. The great density of these fibres, with the absence of 
distinct nuclei, he thinks are adverse to the idea of their being 
muscular. 

Circulation of the Membrana Tympani. — This consists in 
the stylo-mastoid branch of the auricular artery, and the ramus 
tympanicus of the internal maxillary, which forms an arterial 
circle around the osseous margin, analagous to that around the 
iris, from which small branches run to the centre. 

Nerves. — The tympanic plexus is supplied probably chiefly 
from the chorda tympani. 

The membrana tympani receives the vibrations of the air and 
transmits them to the bony chain, and to the air in the tym- 
panum. 

The tympanum is made irregular on the inner and posterior 
surface, by the promonitory, which is a projection of bone indi- 
cative of the situation of the commencement of the scala tym- 
pani. It is found between the fenestra rotunda and the fenestra 
ovalis, the latter being posterior and the former anterior to it. 
Its surface is grooved for the passage of nervous filaments, termed 
the tympanic plexus. Both these fenestra are subtended by 
membranes — the oval foramen, by the membrane of the sacculus 



ANATOMY OE THE HUMAN EAR. 15 

elipticus which lines the vestibule, and the round foramen, by 
a membrane connected with the cochlea. The oval orifice is 
covered in life by the base of the stapes, one of the small bones. 

The eminentia pyramidalis is an irregular little cone of bone, 
on the posterior wall of the tympanum, which is perforated for 
the passage of a small muscle, called the stapedius. 

u Around the superior and posterior margins of the cavity, a 
slight elevation forms the wall of the aquseductus fallopii, and 
marks its course ; a small opening, the apertura chordae, leads 
from it, behind and below the pyramid, giving passage to the 
chorda tympani." 

The Mastoid Cells. — One large orifice or several small ones 
communicate between these cells and the tympanum. The 
enlargement of the ordinary deploic structure results in the 
formation of these cells, which are lined by the same membrane 
which lines the cavity of the tympanum 

The Eustachian Tube. — A small aperture in the lower and 
fore part of the tympanum is the commencement of this tube, 
which proceeds downwards, inwards and forwards, and opens 
into the upper posterior and lateral parts of the pharynx a little 
above the level of the floor of the nostril, and about an inch 
back of the posterior opening. This tube is from an inch to an 
inch and a half long. The opening into the pharynx is enlarged, 
forms an oblique slit, and is guarded by a cartilaginous ring 
which tends to retain any solid body introduced. The tympanic 
portion is osseous and composed of the irregular extremity of 
the pars petrosa of the temporal bone, with a portion of the ala 
and root of the pteregoid process of the sphenoid bone. ct Along 
the superior edge of the osseous portion of the Eustachian tube 
is a canal, separated from the tube, partly by bone and partly 
by a fibrous membrane, transmitting the tensor tympani ) the 
extremity of the canal forms a pulley, around which the tendon 
of the muscle plays, and is thus directed towards the malleus." 



16 THE HUMAN EAR, 

(Pilcher.) The whole tube is lined by a continuation of the 
mucous membrane of the pharynx and the tympanum. The 
ordinary mucous follicles are abundant in it. The uses of this 
tube appear to be : first, to admit air to the tympanum ; second, 
to afford ready exit to the secretions of the latter cavity into 
the throat. 

The bones of the ear are four in number, in the young subject, 
and three in the adult ; termed malleus or hammer, incus or 
anvil, orbiculare or round bone, and stapes or stirrup. They 
are named from their resemblance to these objects. 

The malleus is divided into a caput, cervex, processus gracilis, 
processus brevis, and manubrium. 

The manubrium or handle is inserted between the layers of 
the membrana tympani. It tapers towards the point, which 
latter, however, is a little enlarged and turned outwards. 

The short process is thick and strong and projects outwards, 
forming a right angle with the manubrium, bearing a deep 
depression between itself and the neck. 

The long or thin process is rarely separated from the skull 
in a perfect state. It proceeds forwards and downwards, the 
point being attached to the inner margin of the tympanic ring, 
close to the fissura glasseri. 

The neck by which these processes are attached to the head, 
is short and marked by the attachment of muscles and liga- 
ments. 

The head forms the superior part, rises above the membrana 
tympani, and projects into what has been termed the tympanic 
sinus. It is, on the upper and outer part, convex and smooth, 
concave on its inner and posterior portion, which is divided into 
two parts by a transverse ridge, and articulated to the upper 
surface of the incus. 

The anvil has a body and two limbs. The body is nearly 
square and flat, concave superiorly, and elevated to correspond 



ANATOMY OF THE HUMAN EAR. 17 

to the depressions on the head of the malleus, forming in this 
way a double pulley joint. The smaller crus projects nearly 
directly backwards, and is united to the edge of the mastoid 
cells by a well marked ligament. The long crus hangs down- 
wards, diverging from the manubrium of the malleus. Its 
extremity is moderately enlarged for the articulation with the 
round bone. 

The os orbiculare or lenticulare is found distinct, in infancy, 
but becomes united to the long crus of the incus or the head of 
the stapes, in adult life. It is a mere particle of bone, about 
the size of a large pin-head. 

Fig 3. 




BONES OF THE EAR. 

Malleus. — 2. Incus. — 3. Orbiculare. — L Stapes. 

The stapes is so called from its marked resemblance to the 
ordinary saddle stirrup. Its is divided into a head, neck, two 
crura and a base. This division is perhaps a sufficient descrip- 
tion, except to add that the posterior crus is the longer of the 
two — that the base or foot is placed in contact with the mem- 
brane inside the fenestra ovalis — nearly in a horizontal direction, 
being a little smaller than this foramen, and that the space 
between the crura is subtended by a ligament denominated the 
triangular. 

Another ligament which unites the short crus of the incus 
to the edge of the mastoid cells, with certain duplicatures of 
the mucous membrane form what are termed the ligaments of 
the tympanum. The three following muscles, are perhaps all 



18 THE HUMAN EAR. 

that can be clearly demonstrated as connected with this chain of 
bones. 

1. Tensor Tympani or Interims Mallei. — This arises from 
the superior portion of the Eustachian tube and from the edge . 
of the petrous bone. It runs backwards into the tympanum, 
winding round by means of its tendon over the edge of the 
tube, to be attached to the inner surface of the manubrium of 
the malleus, near the long process. It in this way forms a 
very complete pulley. Use, to draw the bone inwards, and thus 
increase the internal convexity of the membrana tympani. 

2. Laxator Tympani. — This muscle originates in the spinous 
process of the sphenoid bone, runs inwards and backwards 
through the fissure of the glenoid cavity, and is inserted by 
means of a long tendon into the long process of the malleus. 
Use, to draw the malleus outwards and a little forwards, relaxing 
the membrana tympani. 

3. The Stapedius. — Arises from one of the mastoid cells and 
the interior of the eminentia pyramidalis, passing through the 
canal of the pyramid. Inserted tendonous into the posterior 
portion of the neck of the stapes. Use — to move the stapes 
backwards, turning its posterior edge towards the fenestra ovalis, 
thus increasing its tension. 

" The exact influence the muscles of the tympanum exert, in 
regulating the vibrations of the membrane and the bones, is not 
ascertained. The general opinion is that they are voluntary, 
being supplied with nerves from the portio dura; and that the 
membrana tympani is tightened or relaxed at will, as the sound 
may be pleasing or discordant. More correct observations 
however show, that they all, and particularly the tensor tym- 
pani, receive especial branches from the ottic ganglion, besides 
twigs from the tympanic plexus, and thus they may be supposed 
to be involuntary, and to be acted upon sympathetically, through 
the medium of nervous connection with the portio mollis : 



ANATOMY OF THE HUMAN EAR. 19 

resembling the influence of the retina upon the muscular fibres 
of the iris. This forms an interesting problem for solution. 
Probably both opinions are correct; as the muscles are supplied 
from the two sources, — from the voluntary system by the portio 
dura, and from the ganglionic by the chorda tympani, and the 
ottic ganglion. Is it not probable that they may be of the 
mixed character, acting involuntarily when the acoustic nerve 
is over-excited, or when the mind is otherwise engaged, and 
attention not directed to the protection of the membrane and 
of the ear in general ; and being influenced by volition, when 
the individual is desirous to increase or to diminish his mental 
perception Y* (Pilcher, p. 60.) 

Internal Ear, or the Labyrinth. — The internal ear may also 
be divided into three portions — viz, the cochlea, vestibule and 
serai-circular canals. Another division, is into the osseous and 
membranous labyrinths — the first includes the vestibule, semi- 
circular canals and cochlea — or the bones of the two first, and 
the whole structure of the latter. 

The Cochlea. — Its resemblance to a snail's shell has induced 
this name. Their being two cavities however instead of one, 
the analogy is only in external form. It is twice and a half 
turned upon itself, having a base and point. This arrangement 
varies somewhat in the ears of the higher classes of animals : — 
for instance, in the porcupine, it has three and a half spiral 
turns; in the dog and fox three turns; in man, the cow, hog 
and cat, two and a half turns ; in the horse and dolphin, two 
and a quarter ; and in the rabbit two turns. Birds occupy the 
last place in the series. — (Dr. Ch. L. Esser, ffastner's Archives, 
fur aieges. JSfaturlehre, torn, xii., 1 er. Cah; 1827, p. 52.) 
An axis termed the modiolus, from its resemblance to the nave 
of a wheel — infundibulum, cupola, lamina spiralis, hamulus 
cochleae, canalis scalarum communis, and the zona cochleae, 
compose the cochlea. 



20 THE HUMAN EAR. 

The modiolus is the central pillar, which is hollow for the 
transmission of the branch of the portio mollis which supplies 
the cochlea — lateral perforations allow the nervous ramuscules 
to pass over the surfaces of the zonae and scalae cochleae. The 
infundibulum is an inverted conical cavity at the upper end of 
the cochlea, while the cupola is the dome which surmounts this 
cavity. The lamina spiralis doubles twice and a half upon 
itself, and passes round the modiolus. The hamulus cochleae is 
a small hook, forming the terminal point of the lamina spiralis 
above. The two canals meet at the upper end of the cochlea 
under the cupola, and unite, thus forming but one canal, which 
begins in the vestibule there termed scala vestibuli, and termi- 
nates in the tympanum at the foramen rotundum, and there 
termed scala tympani. The zona is the cartilaginous or mem- 
branous portion, which forms the outer border of the bony 
portion or lamina spiralis. On the surfaces of both this and 
the lamina, are distributed the nervous loops, which approach 
them through the cribriform orifices in the modiolus. 

Three small orifices connect the interior of the coch.ea, vesti- 
bule and the bony structure of the pars petrosa, with the exterior 
surface. These are termed, from an erroneous opinion as to 
their functions, aquaeducts. They are designed to be the media 
of conducting nerves, bloodvessels, and perhaps some other 
tissues through the bone. 

Aquceductus Cbchlece. — This duct proceeds from the scala 
tympani, near the fenestra rotunda, backwards, under the 
labyrinth, and perforating the bone, terminates by an irregular 
opening on the lower margin of the posterior surface of the 
petrous portion. Several smaller canals communicate with it 
from the cancelli, in its course. 

Aquceductus Vestibidi. — Originates near the common orifice 
of the superior and posterior semi-circular canals, perforates 
the bone, and descends to the posterior surface of the pars 



ANATOMY OF THE HUMAN EAR. 21 

petrosa near the jugular fossa. By some it has been traced to 
the scala vestibuli. 

Aquccductus Fallopii. — This canal whose function is merely 
the transmission of the portio dura nerve, commences at the 
upper and inner part of the meatus auditorius internus, and 
passes outwards, at first a little upwards and forwards, then 
backwards and downwards, and finally almost directly down- 
wards to the foramen stylo-mastoideum where it terminates. 
At the beginning of it, or near its course, it receives the hiatus 
Fallopii, a narrow canal on the dorsum of the petrous portion 
of the temporal bone, which conducts the vidian nerve to the 
portio dura. Several other small orifices open into it, which 
transmit the chorda tympani and other branches to the tym- 
panum. 

Meatus Auditorius Interims. — This is found on the posterior 
surface of the petrous portion of the temporal bone, and is a 
large canal for the transmission of the portio mollis, portio dura, 
portio intermedia and internal auditory artery to the interior 
of the bone. It is about half an inch in length — passing out- 
wards and forwards; and at its outer extremity or bottom, 
terminates, in a cribriform plate which is divided by a well 
marked transverse ridge. In the upper and smaller portions 
we have the commencement as above described, of the aquee- 
ductus Fallopii. Posteriorly, foramina transmit fibres of the 
portio mollis to the superior semi-circular canal. The lower or 
larger portion is divided into two parts, the anterior of which 
forms the base of the modiolus, and has a distinctly cribriform 
arrangement, the orifices being in circles one within another, 
with a large central orifice. The nerves which pass through 
this bone pass through the modiolus, and are distributed to the 
cochlea. They are branches also of the portio mollis. Through 
the posterior division of the bone, other branches, from the 
game, pass to the vestibule and to the ampulla of the posterior 



22 THE HUMAN EAR. 

canal. The whole meatus is lined by dura mater. An internal 
periosteum lines the whole of the labyrinth, and has the portio 
mollis finely distributed over it. It also secretes the perilymph, 
or that fluid which is outside of the membranous sacks which 
are found in the vestibule and semi-circular canals. 

The semi-circular canals, are three in number, superior, 
external and inferior. They are solid bone, and communicate 
with the vestibule. 

The membranous labyrinth consists in sacks which do not 
entirely fill these canals and the vestibule, and contain a clear 
fluid, like water, called liquor Cotunnii. The vestibular portion 
is said by some to contain two sacks ; the larger and posterior 
is termed the sacculus vestibuli. The semi-circular canals all 
open into this, some by their expanded extremities, termed 
ampullae. The anterior sack is smaller and called alveus utri- 
culosus. Brachet and Eoget describe, in each of these sacks, 
a white, calcareous body, which seems to be suspended by 
means of filaments of the acoustic nerve. 

The nerves of the ear are, 

1. The Auditory, as above described, in its distribution to both 
the solid and fluid portions of the ear; 

2. Portio Dura or Facial Nerve. — It passes from the internal 
meatus, along the canal of Fallopius, until it reaches the stylo- 
mastoid foramen, where it emerges to the parotid gland, and 
thence to the face forming the pes anserinus. 

" The facial in its course through the bone gives a good 
sized twig to the tensor tympani, part of which reaches the 
Eustachian tube, then a filament or two to the tympanic plexus; 
then a branch to the stapedius ; and, lastly, near the termination 
of the aqugeduct, the vidian nerve leaves it under the name of 
chorda tympani/ ; 

3. The vidian nerve enters the cranium through the pterygoid 
foramen, then the hiatus Fallopii passing off from the portio 



ANATOMY OF THE HUMAN EAR. 23 

dura as above described, it passes across the tympanum between 
the Ion or crus of the incus and the handle of the malleus : then 
enters and emerges from the fissura glasseri, unites with the 
true gustatory and passes to communicate with the submaxillary 
ganglion. In its course it communicates with — 1. The 
sympathetic in the carotid canal. — 2. With the portio dura. — 
3. The tympanic plexus receives twigs from it. — 4. The laxator 
tympani. — 5. The ottic ganglion. — 6. The gustatory, and 7. 
The submaxillary ganglion. 

The ottic ganglion, as described by Arnold, " is a small, soft, 
reddish body, larger in proportion in the foetus, situated imme- 
diately below the foramen ovale : it rests on the inner surface 
of the third branch of the fifth, between it and the Eustachian 
tube, and immediately in front of the great meningeal artery/' 

The Tympanic Plexus. — According to Jacobson it is situated 
near the promontory of the tympanum, and is formed by the 
union of twigs from the sympathetic nerve, ottic ganglion, chorda 
tympani, portio dura, and glosso-pharyngeus. The mucous 
membrane of the tympanum, Eustachian tube and the muscles, 
&c. of this cavity are supplied by it. 

The ear is supplied with blood, by branches from the carotid 
and basilar arteries. 

The posterior aural, arises from the external carotid, and is 
distributed to the external ear. It gives off the stylo-mastoid 
branch, which passes through the foramen of the same name. 
This branch afterwards divides into numerous ramuscules which 
are distributed to the mastoid cells, labyrinth, and with a 
branch from the internal carotid termed the ramus tympanicus, 
forms a coronet around the membrana tympani, which sends 
branches towards the centre, like that around the iris. 

The anterior aural arteries, are supplied by the temporal. 
The tympanic passes through the fissura glasseri, and is dis- 
tributed to the coronet as above stated. The internal auditory 



24 THE HUMAN EAR. 

arises from the basilar, and runs along the under margin of the 
portio mollis outwards, supplying this nerve in its course, and 
passing with its ramifications to the various portions of the 
labyrinth. 

The veins and lymphatics correspond to, and are distributed 
with the arteries. 



CHAPTER II. 



PHYSIOLOGY OF THE EAR. 



It is clearly demonstrable, that there enter into the struc- 
ture and functions of the ear, at least three distinct forms of 
matter — viz : gases, fluids and solids : and that it is by an 
union of the acoustic proportions of these, that complete, or 
normal hearing is accomplished. The auricle and meatus 
auditorious externus, are beautifully adapted, to concentrate 
the sonorous vibrations of the atmosphere, and direct them in 
the most forcible manner to the membrana tympani. This 
membrane, receiving probably the vibrations both from the 
meatus and tympanum, vibrates and communicates the vibra- 
tions through the manubrium of the malleus, to the four bones 
which form a solid connection between the membrana tympani 
and the vestibule. The base of the stapes transmits through 
the foramen ovale, and its subtending membrane, those vibra- 
tions, which are thence conducted through the vestibule and 
semi-circular canals, by means of the liquor cotunnii. The 
atmospheric air, the bones and membranes, and the liquor 
cotunnii, are the three media, gaseous, solid and fluid, which 
conduct sonorous vibrations to the acoustic nerve, distributed 
to the semi-circular canals and vestibule. 

The cochlea on the other hand appears to be almost exclu- 
sively solid ; and whether the vibrations be communicated to 

3 25 



26 THE HUMAN EAR. 

it through the general skeleton or from the tympanum, through 
the foramen rotundum, by means of the atmospheric air; still 
the receptacle of sound is solid, being both bony and carti- 
laginous. 

The relative value of these several media may be learned 
from the fact, that sonorous vibrations set in motion in atmos- 
pheric air, at medium temperatures, and barometric pressure, 
move with the velocity of 1,142 feet per second; while 
in water and fluids of the density of water, they pass at the 
rate of 4,708 feet per second; and in iron and hard wood, the 
velocity is increased to 18,530 feet per second. In all these 
cases, the conducting power is diminished, by diminishing the 
density of the medium, and vice versa. At the top of high 
mountains, where the density of the atmosphere is very con- 
siderably diminished, it is said that the sound of a pistol is 
scarcely greater than that of a fire-cracker ; in vacuo also the 
sound of a bell is entirely lost. In clear weather, when the 
barometer indicates a heavy or dense atmosphere, sound is 
communicated much further, and is heard better. When air 
is condensed artificially, also, the sound will be found to in- 
crease with the condensation. 

The laws of vibrating bodies are very interesting, and well 
worthy the attention of the physiologist and scientific surgeon. 
It is found for instance, that tense strings and membranes 
vibrate in sections, between which, there are points termed 
nodal points, where little or no motion is observed. A vibra- 
ting string thus divides itself into a number of sections with 
corresponding nodal or stationary points. The position in the 
musical scale of Guido, of these notes depends on several cir- 
cumstances. — 1. The length of the string vibrating. — 2. 
The velocity of the vibrations. — 3. The size of the string; 
and 4. its density : the latter property being affected as is well 
known, by its dryness or moisture. Almost the same laws 



PHYSIOLOGY OF THE EAR. 27 

exist in reference to distended membranes, in a state of vibra- 
tion. In the latter cases, as in drum-heads, tamborines, &c, 
the nodal points may be demonstrated; by placing sand on 
them, and then causing them to vibrate. The sand will as- 
sume various geometrical figures whose lines will indicate the 
nodal surfaces. 

It is said that engineers, by placing a drum on the ground, 
with a small quantity of sand upon it, are enabled to detect the 
act of mining although no sound can be perceived in any other 
way, simply by the motions of the particles of sand, induced by 
the vibrations communicated to the drum head from the earth. 

The difference between the conducting and the reflecting 
powers of bodies, is as distinct, in reference to sound as it is in 
reference to light. The angle at which vibrations of air, 
thrown off from surfaces on which they are made to fall, like 
that of rays of light, under the same conditions, is equal to 
that of incidence. On this simple law are based the curious 
phenomena of echos, sounding boards in churches and other 
edifices, as well as those of whispering galleries. In the latter 
case, a complete circle, with a continuous smooth surface, appears 
to be essential to their perfection. Arches and domes collect 
and multiply waves of vibrations, in a manner to interfere, 
often, with that purity of sound, in the human voice, so 
necessary in school houses, churches and other public build, 
ings. The writer has been informed that the arched arrangement 
of the chambers in the Grirard college, near our city, precludes 
the possibility of using them for purposes of instruction, until 
the domes are destroyed by means of transverse horizontal 
partitions. On the other hand a number of rough and irregular 
surfaces, absorb sound, so that a room filled with an audience, 
or lined with angular pillars, is much more difficult to fill with 
sound than an empty one, and one whose surfaces are less 
broken. A continuous smooth surface, as that of a high wall, 



28 THE HUMAN EAR. 

the surface of calm water, or of ice, is very favorable to the 
preservation of sound. Battles fought at sea, when the latter 
is calm, as well as those on land, have been heard at a distance 
of two hundred miles and more. 

Two circumstances co-operate to produce this result : — the 
reaction between the vibrating air, and the smooth surface (the 
latter doubtless vibrating with the air, even that of the most 
solid walls;) and the preservation or reflection of the sound, 
without absorption, along the smooth surface. The same laws 
are operative, in cases of speaking trumpets and tubes. In the 
former case, the vibrations of the metal, with the gradual 
enlargement of the vibrating surface, and consequent increase 
of the amount of air acted upon, multiply very much the force 
and numbers of the vibrations. When these are directed 
against any smooth surface, as the expanded sail of a vessel at 
sea ; the side of a hill or a high wall — the sound collected at a 
focal point will be much greater than could be produced by the 
human voice alone, directed to that point. Speaking tubes 
have the advantage of not losing their vibrations, rapidly, in 
the atmosphere — hence the sound, reflected from one side to 
the other of the tube, is augmented by the vibrations of the 
tube itself. Sound is thus actually increased in its passage 
along these conductors. This principle is doubtless operative 
in the meatus auditorius externus, which may be considered in 
the light of a speaking trumpet. The bent form of the tube 
(an angle of forty-five degrees) does not affect materially this 
augmentation of sound. The whole tube, there can be but little 
doubt, both the bony and cartilaginous portions, vibrates under 
these circumstances ; like the parieties of a speaking trumpet. 
The structure of the membrana tympani is well calculated to 
fit it for the reception of the vibrations, thus conducted to it. Its 
extreme tenuity, with the peculiar arrangement of its fibres \ and 
the somewhat relaxed conditions in which it is usually found, 



PHYSIOLOGY OF THE HUMAN EAR. 29 

predispose it to take on a vibratory motion with great facility. 
The principle so well known in musical instruments, called 
sympathy, by which, one body, in a state of quiescence in the 
vicinity of another, in a state of vibration, (of the same tone) 
sympathises or vibrates in harmony with the latter; may exist 
in the membrana tympani as well as in other vibrating bodies. 
The thickening of this membrane from inflammation, or the 
presence of some foreign substance in contact with either of its 
surfaces, must necessarily affect these fine functions very much. 
Query ? how much of the musical ear depends upon the material 
condition of the membrana tympani ? Its vibrations in unison 
with the finer and higher sounds of musical instruments, must 
assist very much in the appreciation of these sounds, especially 
when the cerebral or mental organization is musical. It is 
well known that tension and relaxation of this membrane are 
not only the result of the presence and absence of moisture : 
but are produced by the movements of the oscicuia auditus : 
which are indeed mure or less under the control of the will. 
The vibrations of the membrane are communicated to this chain 
of bones through the manubrium or handle of the malleus, and 
little time is lost in conducting it to the fenestra ovalis ; where 
from the solid bones it is transmitted through another membrane 
to a fluid, the liquor cotunnii. This fluid is arranged in the 
form of three circular arches, which begin and terminate, in a 
general fluid distributed in two sacks — in the vestibule. The 
arches are semi-circular canals, which are bony. The vibrations 
of the fluid arches, it may be supposed, are communicated to 
the bony, or solid tubes, in which they are enclosed. The 
vibrations return to the vestibule multiplied probably, in the 
same way, that sound is multiplied in the atmosphere under like 
circumstances. In addition to this arrangement two osicula are 
suspended in the two sacks, in the vestibule, perhaps by nervous 
filaments of the seventh pair or portio mollis, which is also 

3* 



30 THE HUMAN EAR. 

distributed to the internal periosteum of the bony canals and 
vestibule. The vibrations, thus reach the expanded extremities 
of the nerve, much augmented in force and intensity \ and the 
impression is transmitted to the brain. Where does perception 
take place; at the root of the nerve, or at its expanded ex 
tremity ? 

The physiology of the cochlea, is perhaps more obscure. 
The foramen rotundum may transmit vibrations from the tym 
panum, particularly those received through the Eustachian tube, 
to the scala tympani ; which conducting them to the cupola or 
apex, enables them to pass down again through the scala vesti- 
buli to where the latter opens into the vestibule. They may 
here, join with, confirm or multiply vibrations already received 
through the oscicula and foramen ovale. In the mean time, 
however, the nervous loops, distributed over the surface of the 
scala membranacea may be recipients of the impressions, and 
transmit them directly to the brain. This must be the case where 
from disease or other defect in the semi-circular canals and vesti- 
bule, impressions are not communicated in that direction. 

Webber, of Germany, considers the cochlea as the represen- 
tative, in man, of the auditory apparatus of the fish, whose 
oscicula are merely placed in a bony cavity, and communicate 
sonorous vibrations to the brain, simply as solids. It seems 
very probable, that sounds transmitted to the brain through the 
solids of the body alone (such for instance as those produced by 
a watch held between the teeth, the jar of a floor or partition 
with which some part of the body comes in contact) are perceived 
by means of that portion of the auditory nerve, which is ex- 
panded over the interior of the cochlea. 

It is probable also, that after the loss of the membrana 
tympani and oscicula, the vibrations of the atmosphere are 
communicated through the foramen rotundum, and that the 
perforation of the membrane, is for this reason, followed in 
some cases by improved hearing. 



PHYSIOLOGY OF THE HUMAN EAR. 31 

In reference to the uses of the mastoid cells, it is probable 
that they merely serve the purpose of increasing the force of the 
reverberations of the air. The amount of air in the tympanum 
is, as it were, increased by the additional space of these cells. 
The temperature, pressure, and sonorous vibrations, are thus 
preserved, and perhaps improved. Sudden rarefaction or com- 
pression of the air, as well as variations in its temperature, &c, 
are thus also more effectually guarded against. The uniformity 
of the existence of these cells, particularly in the mammalia and 
birds, proves their utility. In many animals they are directly 
connected with the tympanum, and indeed form a part of it. 
In birds also, they are extended to the -bones. 

They doubtless, in the human subject, act as sounding boards : 
and increase the force of the vibrations of the air in the tym- 
panum. 

The speculations of Sir Charles Bell and others, in reference 
to the musical ear, placing this latter faculty in the membrana 
tympani, or in other parts of the ear are probably imaginary. 

Good hearing, accompanied with the power (cerebral or 
mental) of appreciating musical sounds or harmony; are the 
requisites for the full development of the musical ear. It is 
well known that neither the talent or taste for music is lost, 
with the loss of any portion, or all of the structure of the ear. 
It is probable therefore that the talent is mental — and to a 
certain extent independent of the organ of hearing. Yet, that 
the faculty should exist without the corresponding organ, would 
be an anomaly in that harmony which is so universally observed 
throughout the works of nature. 



CHAPTER III. 



corHOsis. 



The causes of defective hearing, in all its varieties may be 
arranged under the following heads. 

1. Loss of the Auricle. — The use of the auricle, is doubtless, 
that of collecting the sonorous vibrations of the air, and con- 
centrating them upon the external meatus, and through this, 
on the membrana tympani. The vibrations of the cartilaginous 
structure (the pinna) may also assist in transmitting sound to 
the tympanum. The loss, therefore, of the auricle, by accident 
or disease, will be followed by more or less imperfection in the 
function of hearing. This is not so great as many have sup- 
posed ; and no relation has as yet been established, between 
the size of the auricle and the acuteness of audition The 
author, was acquainted some years ago, with a young man, who 
had had the right auricle shaved off by the wheel of a rail-road 
car. In him, the dulness of hearing which followed was very 
slight. 

It is well known, that timid animals, such as the hare, the 
rabbit, the llama and others whose safety from the voracity of 
other animals, is in flight, and whose hearing, must be acute, in 
order to warn them of approaching danger, have large and move- 
able ears. The ass, on the other hand, proverbial for the size of 
his aural appendages, has not as we are aware of been charged 

(32) 



cophosis. 33 

•with cowardice ; or remarkable acute hearing ; the more docile 
dogs — the King Charles' Spaniel, for instance, have long and 
pendulous ears; so also the fox-hound; while the fox, the 
terrier and the bull-dog have short ears. Whether, in the 
human subject the auricle diminishes or not, in proportion to 
the increase or advancement in civilization, as is supposed by 
some, is not decided. Byron says, he was recognized as belong- 
ing to the aristocracy by a Turkish officer, by his small ears. 
"We know very well that the inhabitants of the south sea islands, 
pride themselves on the size of their ears, and take great pains 
to enlarge them by perforating the lobe and dilating it, gradually 
with pieces of wood — until at last a large sized block is intro- 
duced and habitually worn as an ornament. 

Any obstruction in the meatus auditorius externus must 
impede the passage of air to the membrane. These obstructions, 
are: — 

1. Congenital deficiencies, complete or incomplete. A case 
is recorded of a negress in Virginia, who had a congenital 
deficiency of the auricle and meatus of both ears, but who could, 
however, hold conversation with her fellows very well. In 
order to hear what was said to her, she opened her mouth and 
turned her face toward the speaker. She could hear nothing 
or very little with her mouth shut. 

2. Foreign bodies in the meatus. Cases continually occur 
in which foreign bodies are found embedded in the passage, and 
have remained there for many years. Independently of the 
irritation which they produce in the neighbouring tissues, they 
necessarily produce more or less deafness. Cherry pits, grains 
of corn, pebbles and pieces of wood and small buttons, are the 
substances usually found there. 

3. The accumulation of an inordinate amount of the cerumen 
of the part. This is a very common occurrence. The writer 
has seen many cases where the patient has remained months 



34 THE HUMAN EAR. 

and sometimes years, nearly deaf on account of these collections. 
Accurate examination of the passage should in all cases ol 
deafness, be made with a strong light, and the ear speculum. 

4. Polypi and other morbid growths, which take place from 
the membrana tympani, or from the parieties of the meatus. 
These are generally attended with chronic purulent or mucous 
discharges. 

III. Derangements of the membrana tympani. Leaving out 
all inflammations, acute, chronic, or specific, which affect the 
hearing very much during their progress, the following condi- 
tions also affect it much. 1. Thickening of the membrane. 
The color of this tissue, as has elsewhere been stated, is a very 
light pearl or milk and water color, somewhat diaphanous. 
When thickened it becomes chalk-white, or yellowish white, 
and is in a condition in which it is indisposed to vibrate as a 
membrane. The character of a slightly tense membrane is 
lost, and instead of vibrating like a moderately tense sail, with 
each wave of air, on either side, it becomes a more or less solid 
wall, whose vibrations are much more difficult to induce. This 
is the cause of a deafness in one ear, frequently the right one, 
which so many labor under after chronic otorrhea in childhood, 
which has been neglected. In some cases, especially in young 
persons, and where there is no scrofulous tendency, this thick- 
ening of the membrane is removed by absorption — generally, 
however, it remains during life. 2. Calcareous or osseous 
deposits, on or in the structure of the membrane. — These are 
found sometimes in old persons and persons of a peculiar dia- 
thesis. A complete wall is thus formed, which presents a 
barrier to the introduction of sound through the external meatus. 
3. Polypous growths, upon the membrane, which are accompa- 
nied with thickening of its tissues, and sometimes totally obstruct 
its natural vibrations. 4. Partial or complete loss of the mem- 
brane. Perforations of the tunics, partial or complete, are the not 



cophosis. 35 

uncommon results of inflammation and injuries. The membrane 
may be merely perforated or partially destroyed ; the remainder 
being attached to the manubrium of the malleus, or to the bony 
ring around. In this way the defective and relaxed condition 
of the membrane, or its entire absence may be the cause of 
deafness. In some of these cases, it is probable that the use 
of glycerine or some analagous substance, by supplying to a 
certain extent the vibrating properties of the membrane, would 
be useful. These are probably the cases which, as reported by 
the English surgeons, were so wonderfully relieved, and that 
at once by the use of moistened cotton, glycerine, &c. A very 
common experiment to detect these conditions of the membrane, 
the exhalation of smoke, through the Eustachian tubes, by 
filling the throat with smoke — closing the nose and mouth 
forcibly, and attempting to " blow out" the smoke. It finds 
its way out through the tube and meatus, when the membrane 
is perforated or lost. A much better way is to examine the 
meatus carefully with the speculum. The loss of the entire 
membrane, and sometimes that of a part of it, is accompanied 
with the removal of one or more of the oscicula. It is of some 
importance, to know, whether they are all destroyed or not. 
If the stapes remain in situ, as it very frequently does, the 
diminution of hearing is much less than when it also is gone. 
The patient may in fact hear tolerably well under the latter 
circumstances. Where the membrane and the oscicula of both 
ears have been destroyed, the above fact will explain why one 
ear retains its function better than the other, as is often the case. 
IV. Closure or filling up of the Eustachian tubes, or tympani. 
The first condition may be either temporary, or permanent. 1. 
Temporary closures of the Eustachian tube, are often the result 
of inflammation of the mucous membrane of the throat and 
fauces, extending to the tube. Ordinary catarrh, scarlet fever, 
measles, small pox, varioloid and similar diseases, produce this 



36 THE HUMAN EAR. 

condition, and leave the patient more or less deaf in one or 
both ears. The closure may be the result, merely, of the 
swelling of the lining membrane, or it may be caused by the 
formation of a mucous plug, which forms by the inspissation of 
this fluid, in the tube. The opening of the tube, is often indi- 
cated to the patient by a sudden snap, in the ear, with an 
equally sudden increase in the acuteness of hearing. The 
swelling subsides, and the inspissated mucus is thrown out, 
thus leaving the passage open. 2. Permanent closures are the 
results of the same causes, and particularly of chronic inflam- 
mation which produces a permanent thickening of the lining 
membrane, a plug which becomes semiorganized and fixed, or 
one or more strictures, which close the passage. Congenital 
closures must also be arranged under this head. Great care 
should be observed after scarlet fever, measles, catarrhs, &c, 
to have the passage cleared out, soon after the declension of the 
disease ; otherwise, a more permanent closure results, which 
will at first be followed by partial, and finally, in many cases, 
by complete deafness. It would appear that the natural outlet 
of the tympanum being closed, disease, sooner or later sets in, 
and perforates the membrana tympani, or involves other portions 
of the internal ear. As far as the author's experience has gone, 
these closures of the Eustachian tubes are more certainly followed 
by lesions, inducing entire cophosis, than any affections of the 
external meatus, or tympanum itself. 

The consequences indicated are the more likely to follow, 
inasmuch as the tube is somewhat difficult to explore, and also 
as one tube may be closed for a long time, before the patient 
or his friends may detect it. 

2. The tympanum is sometimes filled with pus, blood, a 
cheesy matter, fungus or bone. In either case the accompanying 
deafness is very considerable. Temporary engorgements of the 
lining mucous membrane, are generally relieved, when the 



cophosis. 37 

inflammation which induced them subsides; by the discharge 
of the effused fluids, through the Eustachian tube into the 
throat: or, the membrana tympani having bursted, into the 
meatus auditorius externus. Congenial deficiency is of course 
a cause of deafness, but is generally associated with other 
organic defects. 

V. Diseases of the labyrinth induce deafness and noises in 
the ears. These diseases, at least the pathological conditions 
of the parts, are not very well understood : and are now, in 
most practical treatises, referred to the nervous expansions of 
the part. The deafness which accompanies old age is probably 
in some cases the result of atony of the nerve 5 in others of 
ossification of or deposits in portions of the labyrinth. 

Atrophy of the portio mollis has been found by Dr. Bock ? 
in the ears of deaf mutes, with other defects in the labyrinth. 

It must not be forgotten, that like any other apparatus of 
the body, one part sympathises with another ; and that the 
organ sympathises with other organs and systems in they 
economy. 

We may have deafness, doubtless, sympathetically induced ; 
by disease existing in other organs, as the brain, stomach, 
&c, &c. 

VI. And lastly the root of the acoustic nerve, or the sub- 
stance of the brain itself may be the seat of the disease, and 
the cause of deafness. Y\ r e may now see the folly of speaking 
of cophosis, as a disease. It is in all cases, merely a symptom 
— & very important one it is true, but properly only a symptom ; 
to remove which remedies may be necessary. The publication 
of cases of deafness cured by this or that favorite remedy, as is 
so often seen in our medical journals, is little more definite, 
than that of the most arrant quack. Such publications should 
be considered rather as appeals to an ignorant public, than to a 
scientific profession. Let the known or supposed cause, or at 

4 



38 THE HUMAN EAR. 

least the known conditions of the parts affected be stated ; and 
we will have some rational data on which to infer the modus 
agendi of agents proposed for our use. 

An enlightened empiricism is commendable, and necessary 
in the present imperfect condition of medical science ; but an 
empiricism which disregards well established truths and known 
conditions of the organs, can be of little use in forwarding the 
great object of medicine — the cure of disease. Such publications 
must be placed in the same category, with Dr. Smith's cough 
mixture, pulmonic syrups, anti-dyspepsia medicines, hair tonics, 
acoustic oils, et id genus omne. 

No classification of the diseases of the ear, with which the 
author is acquainted, embraces the whole list without many 
incongruities. This perhaps, in the present state of aural 
surgery, is unavoidable. The following appears to him, to 
approach as near to the desired object as any that has yet ap- 
peared. It is, as will be seen, based chiefly on the anatomical 
structure of the parts. 



BOOK II. 



DISEASES OF THE EAR. 



1. Auricle. 



2. Meatus 
Auditorius 
Externus. 



1. Acute inflammation. 

2. Erysipelatous do. 

3. Phlegmonous do. 

4. Furuncle. 

1. Acute inflammation. 

2. Chronic inflammation without ulceration. 

3. Chronic inflammation with polypi. 

4. Inflammation of the glandular structure. 

5. do. of cellular structure. 

6. do. of periosteum and bone. 

7. Erysipelatous inflammation. 

8. Foreign bodies in the meatus. 



3. Membrana 
Tympani. 



1. Acute inflammation of. 

2. Chronic do. without ulceration. 

3. do. do. with ulceration. 

4. Thickening of the membrane. 

5. Tension and relaxation of, depending 

upon organic changes, and diseases in 
the tympanum 

39 



40 



THE HUMAN EAR. 



4. Tympanum. < 



' 1. Acute inflammation of mucous mem- 
brane. 

2. Chronic inflammation. 

3. Mucous engorgement. 

4. Stricture of Eustachian tube. 
^5. Impervious do. 

5. Labyrinth. -< Nervous Deafness. I ~ 

I J Chronic. 



CHAPTER I. 



DISEASES OE THE AURICLE. 



1. Acute inflammation of the auricle. 

This structure, at once epidermoid, cellular and cartilaginous, 
is subject to acute inflammation from any of the ordinary causes, 
or from the extension of inflammation from the vicinity. 

Treatment. — It may be relieved by the ordinary antiphlogistic 
means, viz : — Cold poultices, cold water, lead water, leeches, 
&c, &c. Inflammation from frost-bite demands great care to 
prevent sloughing. 

The application of snow, cold water, salt and water, &c, &c, 
until the parts begin fairly to react, will be found necessary 
in the beginning. Poultices of flax-seed meal, bread and milk, 
or a solution of acetate of lead, or even leeches, will be proper 
when reaction has taken place, and we desire to reduce the 
resulting inflammation. 

2. Erysipelatous inflammation of the auricle. 

This disease is sometimes sudden in its attacks ; appearing 



DISEASES OF THE AURICLE. 41 

during a single night. It is characterized by a burning, smart- 
ing, or pricking pain in the part, accompanied generally with 
headache, lassitude and general languor. Symptoms of general 
fever not unfrequently precede the appearance of the external 
local symptoms; the " febris erysipelosa" of Hoffman. The 
cuticle swells up very much, almost obliterating the depressions 
on the surface of the auricle, and is of a bright red, sometimes 
of a purplish color. 

The inflammation and swelling, will generally extend to the 
orifice of the meatus auditorius and close it. Accompanying 
this condition of the parts, the tongue will be furred, especially, 
after the first or second day, and a dull stupid sleep will be 
experienced by the patient at night. 

The disease generally terminates with proper treatment, in 
resolution. It must however be always borne in mind, that the 
disease, as its name imports, is a creeping or traveling disease, 
and liable to be transferred not only to the meatus, but to the 
middle or internal ear, or to the brain itself. 

It may pass over the scalp, or creep towards and over the 
face. Fortunately the extent of surface really occupied by the 
inflammation, does not increase in proportion to the space 
traveled over — for it dies as it goes. 

The several forms of simple, vesicular, phlegmonous, bilious, 
and gangrenous erysipelas, may take hold of the organ. The 
most common, is either the simple or the vesicular, which 
terminates by a general desquamation over the whole inflamed 
surface, as the disease declines. 

Treatment. — It must ever be borne in mind, that erysipelas, 
in whatever part of the body it is found, is mostly associated 
with derangement of the digestive functions, and accompanied 
by more or less general fever. 

Mild cathartics — such as Senna and Sulphate of Magnesia, 

with aniseed — or when the tongue has a dark fur on its surface 

4* 



42 THE HUMAN EAR. 

— the Compound Cathartic pill : or what is better, a blue inas3 
pill at night, of three grains, followed by a Senna and Sulphate 
of Magnesia cathartic, each following morning, for three or four 
nights and mornings in succession, will accomplish our purpose. 
This object, the cleaning of the tongue and the restoration of 
the secretions generally, must be attained or the disease will 
not yield. 

The aromatic Spirits of Ammonia, Spts. Mindereri, Acetate 
of Potash, Spts. Nit ; dulcis, or other diaphoretic remedies and 
drinks, will assist in producing a moist condition of the skin, a 
soft pulse, &c, &c. 

The best local application to the auricle, will be the saturated 
tincture of Iodine, applied by means of a camel-hair pencil, 
twice or three times a day. After each application a ground 
flax-seed or slippery elm poultice will keep the parts moist and 
relaxed. This local treatment, with the daily or twice a day 
washing out of the meatus with warm water, by means of a 
syringe, should be continued until the inflammation subsides. 
A strong solution of the Nitrate of Silver, (40 to 90 or 80 
grains to the ounce of water,) applied to the auricle, every 
morning, may be resorted to with good success. The objections 
to the latter remedy are, its blackening the skin and linen of 
the patient, and the length of time which the color remains on 
the cuticle. The mahogany color produced by the Iodine, passes 
off with the cuticle every twenty-four hours ; the discoloration 
produced by the Nitrate of Silver, remains for several days, and 
sometimes for weeks. We need only add that the meatus must 
be carefully watched, and frequently washed out with tepid 
water. If this be not done, the secretions will collect and 
irritate the parts, producing an otorrhoca which may result in 
thickening of the membrana tympani, and a greater or lesser 
amount of deafness. 

Case 1. — Mr. D. W. A young merchant ; not long married 



DISEASES OF THE AURICLE. 43 

had been confined to his counting-house, very closely for a length 
of time, and no doubt at his home, with his young wife ; was 
attacked with head-ache and general languor, which was soon 
followed by an itching, burning sensation in the right auricle. 
On examination, I found the whole auricle swelled, of a bright 
red color, shining and presenting the appearance of well defined 
erysipelatous inflammation. The tongue was covered with a 
thick fur, with a dark brown line in the centre. The skin dry; 
the eyes injected: the pulse excited and no appetite, with slight 
nausea and constipation. I prescribed the following cathartic 
R. Sennae Fol. ^ss. ; Magnes. Sulph. §ss. ; Sem. Anis. 3iss. ; 
Add one pint of boiling water, cover, and when cool, take a 
wine-glassful every half hour, until the bowels are moved. The 
Tincture of Iodine was applied freely to the inflamed surface, 
with a camel's-hair pencil, and a poultice of ground Slippery 
Elm bark applied over the ear. 

The diet to be strictly vegetable — such as rice, corn-bread, 
tea and dry toast, &c. To exclude the air and particularly all 
currents of air from the part. On the next day, I found the 
inflammation had somewhat subsided ; the Iodine had the effect 
of alleviating the pain and smarting, and the poultice had 
relieved the tension of the parts. Directed him to continue the 
cathartic, taking in the morning, a wine-glassful, and another 
during the day should the bowels not be moved twice or three 
times without it. 

This treatment, with the simple addition of washing out the 
meatus carefully with warm water and a syringe, twice a day, 
was continued for five days. Desquamation of the cuticle took 
place, the general health was restored, and a deafness, which 
he had long labored under, in that ear, was not increased. The 
membrana tympani had not therefore been thickened by the 
inflammation. 

3. The phlegmonous form of the disease ; is here as elsewhere, 



44 THE HUMAN EAR. 

accompanied with so great an amount of derangement of the 
system, associated with general debility, that in addition to the 
local treatment, stimulants and tonics are to be resorted to. 

4. Furuncle. — " Preceded by pain of a sharp prickling throb- 
bing, and tearing character, and increased heat, there is formed 
on a circumscribed spot of the auricle, a red, hard tumor, from 
the size of a pea to that of a hazel-nut." " This species of 
inflammation occurs most frequently in the concha, just before 
the entrance of the meatus, in the scapha, and in the cavitas 
innominata, in those parts of the auricle which are throughout 
supplied with cellular membrane, where there is the least of 
this tissue." (Kramer on the Ear. First edition, p. 79.) 

The tendency of this, like most phlegmonous inflammation, 
is to suppuration. Sooner or later, fluctuation will be per- 
ceived and a purulent discharge will follow. The treatment 
should be directed to promote this termination — poultices and 
other emollient applications should be applied externally; and 
anodynes, to relieve the cerebral and other nervous symptoms, 
should be given internally. General principles will be suffi- 
cient to guide the intelligent practitioner in these cases. 

The meatus externus and auricle are sometimes affected 
with an herpetic, ulcerous eruption. It always produces a 
great thickening of the integuments, and the passage is often 
so much closed that a great degree of deafness ensues. The 
ichor, which exudes from the irritated surface, inspissates 
in the meatus, and not only obstructs the entrance of sound, 
but is accompanied with a great degree of foetor. This dis- 
ease is not unfrequent. I have never seen it resist the effect 
of alterative medicines, and the use of the applications employ- 
ed in the following cases. 

Case 1. Miss S. F. applied for a complaint in her ear, 
that had for many months greatly diminished the power of 
hearing. It proved on examination, to be an herpetic ulcer- 



DISEASES OE THE AURICLE. 45 

* 

ation of the meatus externus and auricle. The orifice of the 
meatus was almost closed. With difficulty I introduced the 
nozzle of a syringe, and brought out a considerable quantity of 
inspissated discharge. The oozing of the ichor was very great. 

" She was perfectly cured at the end of two months by taking 
two grains of calomel every day; and the injection of a lotion 
of hydrargyri muriatus cum aqua calcis, and the application of 
the unguentum hydrargyri nitratis." 

Case 2. Mr. E. W. was a similar case, and cured by the same 
treatment in three weeks. [Saunders on the Ear, page 45.] 

The above lotion will be found useful generally in herpetic 
eruptions — especially if they be of a syphilitic character. It 
is made as follows: R. Aquas Calcis, fgvi. ; Calomel Jss. A 
black precipitate falls, which must be shaken up before using. 
This is what is commonly called the " black wash." 



CHAPTER II. 



DISEASES OF THE MEATUS AUDITORITTS EXTERNUS. 



1. Acute inflammation of the epidermoid tissue of the meatus. 
— Previous to presenting a detailed account of the diseases of 
this passage and the membrana tyrapani, it will be proper to 
speak of the best modes of exploring or examining the parts. 

The fact that the passage is somewhat curved, makes it im- 
possible in many cases, particularly in adults, to examine, with 
the eye, the parietes of the meatus and the membrana tympani 

Fig. 4. 




SPECULUM AURIS. 



at its farther extremity. The light should be strong ; and 
sunlight is by far the best. This however can seldom be mado 
to fall upon the membrane without straightening the canal by 
means of a tube termed a speculum. The introduction of a 
probe, to examine the passage, is not generally advisable, except 
in cases where it is closed, or partially closed, by some foreign 
body or morbid growth. The short bristly hairs at the mouth 
46 



DISEASES OF THE MEATUS AUDITORIUS EXTERNUS 47 

of the meatus, present also an obstacle to ocular examination. 
True, we may by directing the auricle towards the sun, pulling 
it upwards and outwards, drawing the tragus outwards and on 
one side, and inclining the head of the patient strongly in the 
opposite direction, see the membrane, in many cases where there 
is little or no disease m y but generally a speculum auris is neces- 
sary. Fabricius Hildanus is said to have been the first to invent 
such an instrument ; the arms of which have more or less of a 
pyramidal form. The accompanying cut will perhaps sufficiently 
illustrate the speculum auris. [Fig. 4.] The tunnel should be 
painted black on the inside, so as to reflect as little light as 
possible. The spring between the handle blades will keep the 
tunnel closed, while being introduced to the meatus; and 
pressure on the blades will expand the tunnel, in the passage, 
to the proper extent. A strong artificial light, should the sun- 
light not be accessible, may be obtained from an Argand lamp, 
arranged as in the magic lantern. [Fig. 5.] A gas light, or 
one or two wax or spermaceti candles are good substitutes for 
the lamp. There is no excuse in any case, simple or important, 
for neglecting the use of the speculum ; whether the light used 
be artificial or sunlight. 

Inflammations of the meatus are most common in infancy and 
childhood — the parts becoming less vascular, and consequently 
less subject to inflammation, as we advance in years. The 
middle and internal ear is far more subject to disease in the 
later periods of life. 

Acute inflammations occurring from cold, exposure or draughts 
of air, or from sympathy with inflammation or irritation in 
other parts, particularly the gums, in young children, and the 
eyes in older persons, are very liable to pass into the chronic 
form, and to be accompanied by more or less discharge from the 
meatus. The cause acts either alternately on one passage and 
then upon the other, or the action is transferred by sympathy 



48 



THE HUMAN EAR. 
Fig. 5. 




from one ear' to the other. For it is found in some cases, that 
the subsidence of inflammation, in one, is immediately followed 
by its establishment in the other. The same thing, it is well 
known, takes place in the eye ; and in the latter instance we 
have several times observed that the pupil of one eye was 
expanded equally with that of the other, on which the extract 
of belladonna had been placed previous to operating for cataract. 
Close attention should therefore be paid, in the treatment of 
both eye and ear, that the well organ do not take on morbid 
action with or after the diseased one. This will sometimes take 
place, without any cessation of the inflammation in the organ 
primarily affected. 



DISEASES OE THE MEATUS AUDITORIUS EXTERNUS. 49 

That acute inflammation of the meatus as well as chronic, is 
purely sympathetic in many cases, especially with the gums 
during the period of dentition, we have abundant evidence. 

Fortunately, both the primary and secondary irritation may 
be transferred to a third locality, whose sympathies are less 
active and whose structure is less important. 

Acute inflammation of the external auditory canal, begins 
with a dull pain or sense of fullness in the ear, which increases 
to acute pain. The pain becomes lancinating, and spreads 
through the head and over the side of the neck ; and is increased 
by the motions of the lower jaw. 

A loud buzzing sound is experienced in the ear, accompanied 
with more or less deafness. The tube soon becomes more or 
less closed by the swelling; and vesicles, or even pus, will be 
formed, and a sero-purulent discharge will take place from the 
painful and swollen tube. In bad cases, the disease is ushered 
in by rigors, followed by severe febrile symptoms; the head 
partaking largely in the morbid sensations. The discharge is 
not unfrequently very offensive, especially after the disease 
becomes chronic, which it is very liable to do. Even blood 
in some cases is discharged. Most of the severe symptoms 
begin to subside as soon as the discharge is fully established. 

The above symptoms are all present in simple inflammation 
of the tegumentary lining of the meatus ; but are much increased, 
and followed by the bursting of an abscess, when the inflamma- 
tory action is deeper seated. 

Abscess of the areolar tissue is a more severe disease, and 
may terminate by opening into the canal, or behind the ears, as 
I have seen in several cases. 

Treatment. — General bleeding may, where the system is ple- 
thoric, and there is a strong tendency to cerebral congestion, 
be resorted to ; but generally, free leeching, behind and before 

the auricle and below the lobe, will be found of great use. 

5 



50 THE HUMAN EAR. 

Emollient poultices of linseed meal, bread and roilk, or slippery 
elm "bark, should be applied immediately after the free applica- 
tion of leeches. 

The bowels should be well moved by senna and sulphate of 
magnesia — and the patient placed on the simplest vegetable 
diet. The head should be kept elevated, and, after free evacua- 
tions and poulticing, anodynes will be found useful ; to procure 
sleep. 

As soon as the swelling and inflammation subside, the 
meatus should be carefully washed out, by means of a syringe 
and tepid water. This should be done at least three times a 
day. The secretions should not be allowed to remain in the 
tube. A little clean soft wool should be kept in the passage, to 
absorb fluids as they are produced. This should be frequently 
removed and fresh wool placed in the canal. To prevent the 
establishment of a chronic discharge, the cure should be made 
complete by injecting, from time to time, after washing out the 
canal, a solution of acetate of lead, from three to five grains to 
the ounce of distilled water. Should this not prove effectual, 
a mild eruption over the mastoid process, induced by the 
application of croton oil, will be proper. 

2. Chronic Inflammation of the Auditory Tube. — This 
condition of the meatus is either the consequence of acute 
inflammation, pre-existing in the passage; or it originates 
directly from exposure to cold, moisture, or a draught of air; 
or it is induced sympathetically, from an irritated condition 
of the gums or other parts. It may also be the result of a 
scrofulous diathesis. Where this is the case, the disease may 
continue for years. 

Treatment. — After carefully washing out the meatus by 
means of a syringe and tepid water, the whole canal and mem- 
brana tympani should be carefully examined in sun-light, or 
with a strong artificial light. The whole passage will be found 



DISEASES OF THE MEATUS AUDITORIUS EXTERNUS. 51 

red ; tender, and more or less swelled. A small half-moon 
blister, cut to fit the bare space behind the ear — the surface 
and blister being previously moistened with vinegar — should 
be applied at once. Cooling lotions, chiefly solutions of the 
acetate of lead, with a little acetate of morphia, where the 
nervous irritation is considerable, should be carefully injected 
into the meatus, after the secretions have been syringed out. 
This should be done at least three times a day ; while the 
blistered surface, after the plaster has remained on from two to 
four hours, should be covered with a soft bread and milk 
poultice. Should the tongue be furred or the bowels constipated, 
a mild cathartic should be exhibited. In young children, a little 
castor oil, or a teaspoonful or two of syrup of rhubarb, should 
be given. The diet should be moderate in amount ; and all 
animal food strictly forbidden, and generally a purely vegetable 
food recommended. This disease, it must be borne in mind, 
although occurring in the adult is most commonly a disease of 
infancy or childhood. The following prescription will be found 
beneficial when used as above directed. 

R. Plumb, acetat ; gr. x. 
Morph. " gr. i. 

Aquas Distillat. f^iii. 
M. 
or the following: R. Plumb, acetat. gr. x. 

Aquas distillat. fgiii. 
M. 

In the adult, when the tongue is furred, and dark in the centre, 
two or three of the officinal compound cathartic pills should be 
given in the morning or at bed time ; to be followed by a dose 
of rhubarb and magnesia, castor oil, or what is better, a cathartic 
of senna, sulphate of magnesia, and aniseed. The treatment in 
other respects is the same in adults as in children ; except that 



52 THE HUMAN EAR. 

in the latter, the gums ; when softened, should be lanced, or 
the local irritation, wherever seated, with which the inflammation 
of the meatus sympathises, should be removed. In either case, 
(adult or child,) should the general appearance of the patient 
indicate a scrofulous diathesis, we must resort to feruginous or 
other eutrophic remedies, administered internally. A good 
preparation for children from two to nine years of age and 
upwards, is the following. ] 

R. Ferri carb. precipitat. Qiss. 

Zingiber pulv. gr. vi. 

Khei pulv. gr. xvi. 

01. anis. gtt. i. 

M. Dividend in chartul, no. 15. 

Take two powders per diem, in a little syrup or molasses. 
The dose should be doubled in patients sixteen years old, and 
made three times larger for adults. In cachetic constitutions, 
the writer has found this prescription, with a milk diet, or a 
compound one of the milder meats and wholesome vegetables, 
fresh air, cold bathing, exercise and the use of the flesh-brush, 
very effectual. The compound syrup of sarsaparilla, with 
about four grains of the iodide of potassium to each fluid ounce, 
given in tea-spoonful doses, diffused in a wine-glassful of water, 
twice or three times a day, will be found beneficial in giving 
tone to the digestive organs and improving the general nutritive 
functions. The diet in this case should be Indian corn bread, 
mush, rice, boiled milk well salted, mashed potatoes, good stale 
bread, made of rye, wheat and corn mixed, cold water, roasted 
and ripe fruits; and, generally, vegetable and unirritating 
articles of food. In adults, mutton or good beef may be used 
in moderation, but no pork, nor animal oils. 

3. Chronic Inflammation with Polypi. — If instead of finding 
the meatus red and smooth as above described, we discover it 



DISEASES OF THE MEATUS AUDITORIUS EXTERNUS. 53 

filled up or partially closed with a fleshy substance, from whose 
surface and the surrounding parts, the fluids are thrown off, 
we may conclude that there are one or more polypi in the 
passage. The ordinary varieties of polypi found in other mucous 
passages, are also found here. 1, simple : 2, malignant or bloody. 
The polypi of the parietes of the meatus, have generally, small 
pedicles and large heads, while those of the membrana tympani, 
as will be seen in another place, are small, with broad faces and 
small apices. 

Treatment. — The larger polypi should always be removed or 
destroyed in one of the following modes. 1. With a small 
scissors, clipping off the pedicle. 2. By means of a small pair 
of forceps, with which they are to be seized and twisted off. 
3. The ligature, generally one of wire, by which they may be 
strangulated or even torn off. 4. Caustic. The nitrate of 
silver, in stick form, pointed and applied to the polypus once a 
day until it is destroyed. The patient should be placed in the 
ordinary position for examining the passage, the speculum 
applied and the instruments above indicated, or the caustic 
carefully passed to the polypus. After the extirpation of the 
polypus, it is generally well to apply the nitrate of silver, in 
stick, to the surface, or to destroy the root, as it is well known 
that polypi like the vegetable fungi, are very apt to be reproduced 
and that rapidly, after mere excision or extirpation. Should 
this be the case, the growing substance must be repeatedly 
removed and the nitrate of silver applied to the diseased sur- 
face. 

The accompanying inflammation, when any, should be con- 
trolled by the ordinary means; viz. blisters or croton oil behind 
the ears; with the injection into the meatus of a mild solution 
of the acetate of lead. " Si sordida ulcera sunt, (adds Celsus,) 
melius mulso elusunter; et turn aliquod ex his quae supra 
scripta sunt, quod mel habeat, infunditur." He refers to several 

5* 



54 THE HUMAN EAR. 

stimulants, astringents, acids and wines, good, in his own words, 
"ad omnium aurium vitia." The following recommendation 
will be found, doubtless, to be good practice now as it was then ; 
" Si magis pus profluit et caput utique tondendum, et multa 
calida aqua perfundendum, et gargarizandum ; et usque ad 
lassitudinem ambulandum, et cibo modico utenduni." We 
cannot forbear quoting the following elegant passage from the 
same author, and with it will close our account of polypi. 

1 Quod si super ulcera caro increvit, eaque mali odoris, et 
sanguinem fundit, aqua tepida elui debet, turn infundi et quod 
ex thure et aerugine, et aceto, et melle fit, aut mel cum aeru- 
gine incoctum. Squama quoque aeris cum sandaracha contrita 
per fistulam recte instillatur." Lib. VI. p. 375. 

Case 2. Mr. J. B., a young clergyman, consulted me in 
Geneva in the winter of 1848-9, for a chronic discharge from 
the right ear. He had consulted many physicians without 
material relief. The hearing distance, with my watch, was 
diminished to 1J inches. On close examination with the spe- 
culum, in a good sunlight, I detected at the bottom of the 
meatus, and near the margin of the membrana tympani, two 
small red conical polypi, which bled slightly on touching them 
with a probe. The membrane itself was slightly thickened, 
probably from previous inflammations. I applied the nitrate 
of silver in the form of stick, sharpened to a point, several times 
on successive days. Used as an injection a solution of acetate 
of lead, four grains to the ounce; which I directed my patient 
to take home with him and use after washing out the passage 
with tepid water, twice a day. I afterwards learned from him 
that the discharge entirely ceased, but that some deafness re- 
mained; probably on account of the thickening of the membrane. 

Case 3. In 1842, Dr. B. sent me a boy to the surgical clinic 
of the Philadelphia Dispensary, about eleven years of age, who, 
according to his mother's statement, had had a chronic discharge 



DISEASES OF THE MEATUS AUDITORIUS EXTERNUS. 55 

for more than two years. On simple inspection without the 
speculum, I discovered the meatus to be nearly full of one or 
more polypi. The discharge was abundant and foetid, and the 
general health of the. boy seemed to be affected. 

With a pair of small forceps I twisted out one polypus of 
considerable size, directed the use of warm water, and lead-water 
lotions and a blister behind the ear. At the end of four days, 
I extracted another, and at the end of another week still another. 
After each of the last two operations I applied the nitrate of 
silver to the parts and prescribed the carbonate of iron, rhubarb, 
and ginger. The polypi were finally removed and the parts 
healed, leaving a slight deafness, due doubtless to the thickened 
membrana tympani. 

Case 4. Mr. 0. A young merchant applied for relief from a 
moderate purulent discharge from the right ear, which had 
existed, off and on, from childhood. The hearing distance, by 
the watch, had diminished to about three inches. Tenderness 
on pressure of the meatus was experienced. On close examina- 
tion with the speculum I found the membrana tympani red, 
thickened, and two or three small polypous elevations on its 
surface. A general tenderness existed in the course of the 
canal. He was first purged, and a blister placed behind the 
ear on the mastoid process, and then, with a pencil of nitrate 
of silver, the polypi were touched, through the speculum, daily, 
for about two weeks. A solution of nitrate of silver, two grains 
to the ounce, was used, together with ablutions with tepid water, 
twice a day. At the end of four weeks the discharge had 
ceased, and the polypi had disappeared, leaving thickened spots 
on the membrane. 

Case 5. Mr. Brush has suffered from deafness for four years, 
with now and then a slight discharge from the left ear. A 
small polypus, red and conical, was found near the membrane, 
which has been entirely destroyed by four applications of the 



56 THE HUMAN EAR. 

nitrate of silver. The hearing is improved; but remains dull, 
as in the above cases. 

4. Inflammation of the Glandular Structure of the Meatus 
Auditorium Externum. — This disease, according to Kramer, is one 
of the most incurable of those of the meatus. "We must remem- 
ber, however, that this author's account of the disease is a very- 
confused one. He mixes up, under one head, acute inflammation 
(erysipelatous ?) glandular or follicular inflammation, polypi, 
foreign bodies in the passage, chronic otorrhea, &c, &c, &c. 

The symptoms of acute inflammation of the follicles are very 
nearly those of acute inflammation of the tegumentary lining 
tissues. The secretion of cerumen, which characterises rather 
the declining or chronic stage of the disease, will also point it 
out. The "ring of cerumen/' around the membrana tympani, 
dwelt upon by Kramer, indicates nothing, as it is a very common 
condition of the parts, in perfect health. The collections of 
cerumen, which are so common, of a dark color and hard in 
consistence, sometimes filling one third, one half, or two thirds 
of the meatus, forming a complete plug, by which the function 
of hearing is very much impaired, will be spoken of elsewhere. 
These collections, it must be recollected, are frequently overlooked 
for want of careful exploration with the speculum and probe. 

The practice of washing out the ears in the ordinary way, 
even with a syringe, produces a species of membrane on the 
external surface of this ceruminous plug, which may and has 
been mistaken, by a careless observer, for the membrana tym- 
pani. 

Chronic Inflammation of the ceruminous follicles, is charac- 
terised by little or no pain or tumefaction, but is associated 
with considerable discharge of a very foetid character. It is 
generally accompanied with more or less cophosis and noises in 
the ear. The deafness arises from the presence of the fluids in 
the canal, and the noises from the sympathetic nervous irritation. 



DISEASES OF THE MEATUS AUBITORIUS EXTERNUS. 57 

Treatment — In addition to the treatment recommended 
under the next head, or otorrhea, we should adopt more or less 
of an alterative practice in these cases. The use of muriatic or 
nitric acids both as washes in the proportion of J gtt. to the 
ounce of water, and internally in moderate doses should be 
resorted to. Washes of nitrate of silver will also be found of 
great benefit in these cases, care being taken at all times not 
to use the lotions in the meatus too strong. The sensibility 
of the parts, is perhaps as good a guide as any. Counter irrita- 
tion long continued, and even issues on the back of the neck or 
on the arm, will be found useful. Should evidences exist of a 
more or less general derangement of the follicular structure of 
the mucous membranes, iodine, sarsaparilla, and other alteratives, 
should be resorted to. Some soft clean wool should be worn 
in the meatus, and should not be allowed to remain long 
saturated with the secretions. 

Mrs. Dr. Gr., a lady of rather a strumous habit, requested my 
advice at the instance of her husband. I found the meatus of 
each ear, red, inflamed, and painful; discharging abundance 
of an amber colored fluid, which on being exposed to the air, 
at the external orifice of the meatus, rapidly dried into scales, 
which surrounded the opening, and irritated the integument in 
the vicinity. The hearing was materially affected and the pain, 
itching, and uneasiness were very great. I prescribed cooling 
cathartics, blisters behind the ears, and a eutrophic in the 
form of comp. syr., sarsa, with iodide of potassium. 

The treatment was effectual, and in three weeks the disease 
was cured, after many other remedies had been used. This 
discharge will be found always to irritate the parts over which 
it passes 3 and the whole meatus in the above case was quite 
tender on pressure. 

5. Inflammation of Areolar Tissue. — -This inflammation is 
phlegmonous, and is characterized by deep seated and darting 



58 THE HUMAN EAR. 

pains, with heaviness of the head, tenderness of the passage, 
and noises in the ear. It terminates after very severe pain, in 
free suppuration, which should be encouraged by poultices, 
fomentations, and warm water. 

6. Inflammation of Periosteum and Bone. — The inflammation 
of the areolar tissue sometimes attacks the neighbouring perios- 
teum and bone by contiguous sympathy, especially if there be 
a scrofulous diathesis. On introducing the probe, after free 
suppuration, it will be found to come in contact with dead or 
exposed bone, which will, in many, if not most cases, exfoliate, 
and be thrown off. 

Treatment. — The passage should be carefully syringed out 
with tepid water. The exfoliating bone should be removed as 
fast as possible when it becomes lose ; and when any peculiar 
diathesis of the general system is associated with the local 
disease, eutrophic remedies, to meet the indication, will be 
necessary. In young children, the growth of the system seems 
to protect it from the spreading of this inflammation ; the 
scrofulous diathesis, as is well known, in many cases passes off, 
or becomes internal, in the form of tubercles, in a few years. 
It is astonishing how much disease, in some instances, these 
parts will bear in young children, without destroying the function 
of hearing. The bony portion of the meatus and the mastoid 
cells will be involved, and portions of bone thrown off for 
months, and sometimes for years, without affecting materially 
the middle or internal ear. This fact should not, however, be 
relied on by the judicious surgeon in the treatment of the 
disease ; on the contrary, every effort should be made to remove 
the affection as soon as possible. 

7. Erysipelatous Inflammation of the Meatus Auditorius 
Extemus. This may perhaps be divided into acute and chronic. 
The whole passage may be affected co-ordinately with the auricle, 
whether the disease be acute or chronic. 



DISEASES OF THE MEATUS ATJDITORIUS EXTERNUS. 59 

The acute form will demand the same treatment here as 
when located in the auricle. 

In the chronic form, a scaly eruption is thrown off from the 
surface, which, mixing with the cerumen of the passage, tends 
to fill the latter, and cause deafness. Small vesicles are 
formed and burst into the canal, yielding a water viscid dis- 
charge, which is very annoying to the patient. A sense of 
itching with slight pains from time to time is experienced. 

Treatment. — Counter irritation behind the ear, the introduc- 
tion of mild oils, almond, the oleine of lard, mixed with a few 
drops of rose water, will soften the morbid collection of scales 
and sooth the irritated surface. At the same time care should 
be taken to keep the general mucous membranes in a healthy 
condition. We generally find associated with this condition 
of the ears, a dry and scaly skin — a furred tongue and languid 
digestion. These should be corrected by bran baths, laxatives, 
followed by sarsaparilla or other alteratives. Dulness of hearing 
is a very common accompaniment of this condition of the meatus 
and membrana tympani. 

The various eruptions of the general surface are also trans- 
mitted to the meatus, measles, scarlet-fever, small-pox, and 
varioloid produce inflammatory affections and morbid discharges, 
which induce thickening of the membrana tympani, and other 
evils. 

OtorrTicea. — The subject of otorrhcea, or a discharge, some- 
times purulent, from one or both ears, is one of considerable 
importance, both to the patient and to the medical practitioner. 
The disease is very common, particularly in infancy and child- 
hood. From being at first a discharge from the lining mem- 
brane of the meatus auditorius externus, affording relief to some 
other local irritation, and acting on the principle of counter 
irritation, it becomes chronic, and is itself a disease. 

In teething, ophthalmia, and other inflammations, nature 



60 THE HUMAN EAR. 

very commonly establishes this discharge, which undoubtedly 
relieves these diseases. 

From this fact, which is matter of common observation, both 
among the profession and the people, together with the aphorism 
which says, " Suppression of discharges from the ears induces 
diseases of the brain," it is an every day affair to see otorrhoeas 
entirely disregarded, and no means whatever taken to heal them. 

So general is this, that individuals reach the period of 
puberty with this affection in one or both ears. The evil con- 
sequences of such continued disease, with a regular purulent 
discharge for years, (in one case lately under my care of 
thirty-two years,) may be easily conceived. The lining mem- 
brane of the meatus becomes thickened ; the membrana tympani 
is destroyed ; the bones of the ear are loosened and discharged, 
the inflammation, as I have seen in more cases than one, attacks 
the mastoid cells, and forms fistulse opening externally. 

In some cases the progress of destruction is more summary, 
and the disease, passing through the delicate organs of hearing, 
attacks the membranes, and even the substance of the brain, 
producing then, and not till then, u convulsions" and death. 

The latter termination, though by no means so frequent as 
might be imagined from the proximity of the disease to the 
cerebral organs, is yet sufficiently common to make the subject 
a matter of grave consideration. At the same time it must be 
borne in mind, that this introcession is liable to take place at 
any time during the existence of a chronic otorrhoea ; and parti- 
cularly is it the case on exposure to a cold and damp atmosphere, 
or to any of the causes of colds or inflammations. 

The evils, then, of the prolongation of this disease, may be 
arranged as follows : 

First. It is inconvenient, the fluids not unfrequently being 
very offensive. 

Secondly. A permanently diseased condition of the meatus 



DISEASES OF THE MEATUS AUDITORIUS EXTERNUS. 61 

auditorius is produced — or, the bones being attacked, we may 
have ulceration or suppuration established in the cellular struc- 
ture of the mastoid process, which may continue for a long 
time. 

Thirdly. The destruction or ulceration, or what is very com- 
mon, the thickening of the memhrana tympani ; the latter 
result being, not unfrequently, induced in a few days from an 
otorrhcea. It is well known, in fact, that a very large propor- 
tion of individuals, who are supposed to possess good hearing, 
have partial deafness in one ear at least, and sometimes in 
both, from this cause. 

The ulcerative process takes place rapidly in the delicate 
diaphanous membrane of the tympanum ; and although it has 
been shown by some good writers that the perforations induced 
by ulceration, may by proper treatment, be healed ; yet where 
there is no treatment, and the ulcerations heal up in the ordi- 
dary course of the disease, it is fair to infer that the perforations 
remain for life. I recollect when a boy, in company with 
others, boys and men, a common amusement among them was 
to blow smoke from the segars they were using, out through their 
ears. And a considerable per centage of these individuals in a 
country village could perform this feat. The destruction of 
the. membrane itself, however, I suspect, is the most usual 
termination of the disease. After this it not unfrequently gets 
well itself, and the discharges cease. 

Fourthly. The ossicula auris are loosened and discharged, 
and the fenestra ovalis is exposed to the contact of atmospheric 
air. The apparatus so important to good audition — viz., the 
membrana tympani and bones of the ear — being lost, the 
function must necessarily be very much impaired; in some 
cases the Eustachian tubes close, and in this way the external 
and middle ears are entirely impaired. 

Fifthly. The possible, nay probable, occurrence of a transfer 

6 



62 THE HUMAN EAR. 

of the inflammatory action to the brain or its membranes, by- 
metastasis or continuous inflammation, is an argument of the 
highest importance in this discussion. 

Sixthly. The partial or complete loss of the function invari- 
ably accompaning the disease, should be inducement enough for 
us to investigate the propriety of allowing these discharges to 
continue, without medical interference. 

The arguments in favour of non-interference may be summed 
up in a few words : 

First. It is a diverticulum of nature which it is dangerous 
to interfere with. 

Secondly. It very frequently (the object of nature being 
obtained) heals up itself, leaving no great derangement of the 
organ. 

In reference to the first, we would remark that although a 
diverticulum, or source of counter-irritation, and in some cases 
protecting important organs, yet the seat of the discharge is 
itself an important organ, and no man would select that as the 
place to establish counter-irritation in the case of disease in any 
other organ, especially as it is well known that a purulent 
discharge from behind the ear, the back of the neck, or the arm, 
would be productive of all the good effects claimed for a dis- 
charge from this locality. 

We might with the same propriety establish inflammation in 
the eye, for the relief of cerebral, dental, or aural diseases, and 
in this way impair or destroy the function of that organ, whose 
structure is so delicate, and yet no more delicate than that of 
the ear. 

But, say the advocates of the do-nothing-practice, what are 
you to do ? " Suppression of discharges from the ears induces 
diseases of the brain," and daily experience shows this to be a 
fact. Granted. Cannot the disease be transferred from the 
organ of hearing to some other less important part, and there 



DISEASES OF THE MEATUS AUDITORIUS EXTERNUS. 63 

maintained to an indefinite period without the danger of pro- 
ducing any evil consequences? Certainly it can; and if not 
cwed in the sense meant by the above aphorism, yet its seat 
of action may be changed, and ultimately, by judicious attention 
to the case, allowed to heal up entirely, as is the practice in 
almost any other instance, where for a time an issue or purulent 
discharge is desirable. There is nothing peculiar in the struc- 
ture of the ear, that gives it any superiority as a seat of inflam- 
matory action, to relieve other parts in a diseased, or tending to 
a diseased condition. So far from this being the case, we are 
of the opinion that the skilful physician is not justified in allow- 
ing this discharge to continue a single day in any case, where 
he, by slight irritation behind the ear, or the back of the neck, 
or other parts, is enabled to arrest it, but on the contrary he 
should be as anxious to stop it as he is to arrest a purulent 
ophthalmia or other inflammatory affection of the eyes. 

We cannot agree with Dr. Bonnafont, as quoted in No. 5, 
of "Banking's Abstract/' that u chronic mucous discharges 
from the ear are always owing to ulceration of the parietes, of 
the external auditory canal, or of the membrane of the tympa- 
num/' For it is well known that polypous and other growths 
produce the same discharges, and great care should be taken in 
the examination of the auditory canal, with the speculum in a 
sun light, lest these productions escape our notice. They 
should, in fact, be always suspected to exist in cases of chronic 
otorrhoea. That " these discharges, generally very easily treated 
in their acute stage, frequently become very obstinate, and 
terminate in disorders which almost always involve a more or 
less serious degree of deafness, and sometimes the death of the 
individual," are facts which should influence the profession, we 
are fully convinced. 

We have found, in reference to the treatment, that in the 
early stages, in uncomplicated cases, the production of moderate 



61 THE HUMAN EAU. 

irritation behind the ear — with careful syringing, first with 
tepid* water, to wash out the secretions, followed by a solution 
of the plumb, acetat., in the proportion of from two to six grains 
to the ounce of distilled water — was all that was necessary. A 
small half-moon blister, or a drop or two of croton oil, or the 
latter used in the form of unguent, are means usually resorted 
to, to establish this irritation. When complicated, however, 
with general or local disease, acting as concomitant, and some- 
times, as the cause of the otorrhoea, the treatment must neces- 
sarily be varied to suit the case. Scrofula, particularly in 
children, is a very common condition connected with the disease, 
and requires the usual constitutional treatment, in addition to 
the local applications. General debility, gastric irritation,, 
papular eruptions, spreading erysipelatous and other cutaneous 
diseases, induce otorrhoeas, and should be treated accordingly. 
Cases of simple aeute otorrhoea, induced by cold or any of the 
common causes, are treated so successfully by the above, or 
similar means, that the publication of cases would scarcely be 
deemed advisable. Of the chronic forms, however, which are 
considered more difficult to cure, and many of which are abso- 
lutely incurable, the following cases may be found instructive. 
Miss B., aged fourteen years, light complexion, rather full 
habit, has had a discharge from both ears for about a year ; 
hearing distance with a watch, in left ear, one foot ; in the right 
the watch could be heard indistinctly when placed in contact 
with the ear. The treatment consisted in washing out the 
canal well, with tepid water, and then throwing in the aqueous 
solution of the acetate of lead ; four grains to the ounce ; and 
the application of blisters behind the ears. The hearing began 
to improve immediately, so that at the end of a week the 
discharge from the left ear had ceased, and the hearing distance 
increased to six feet. The hearing distance in the right ear 
was restored to four inches, the discharge continuing. At the 



DISEASES OF THE MEATUS AUDITORIUS EXTERNUS. 65 

end of four weeks the improvement in the right ear became 
stationary, at ten inches hearing distance ; the discharges 
though small, remained. 

On close inspection it was found that a moderate sized poly- 
pous growth had been overlooked, on account of the tumefaction 
in the first examination, in the lower part of the middle third 
of the auditory passage. This was carefully excised, and the 
blister surface restored behind the ear — with the use of the 
aqua plumbi. In four days the discharge had nearly ceased ; 
the hearing distance advanced to two feet ; and in ten days the 
discharge of both ears no longer existed ; the hearing distance 
was respectively six and ten feet. 

Second case, August 1846. — Mr. B., an artist, dark com- 
plexion, aged thirty-four years, has had a discharge from both 
ears ever since he was two years old. The hearing distance, 
as indicated by my watch was, in the left ear two inches, in 
the right ear four inches. 

On examination with the speculum, the membrane of the 
tympanum of the left ear was entirely destroyed, together with 
the bones of the middle ear. When air was driven by the 
patient through the Eustachian tube, the fluids were seen to 
bubble and heard to rattle in the ear. 

The discharge from this ear was not great, and chiefly of a 
thin watery character. 

The membrane of the tympanum of the right ear was des- 
troyed to about two-thirds of its extent, and the bones of the 
ear were exposed; the handle of the malleus projected into the 
portion of the membrane which remained, which was also 
thickened and ulcerated, discharging with the surrounding 
surface a large quantity of foeted purulent fluid. The Eusta- 
chian tube was here also pervious, as shown by the air press 
and catheter, and by voluntary sufflation. 

Half-moon blisters were applied behind the ears, and an ear 

6* 



66 THE HUMAN EAR. 

lotion of four grains of the acetate of lead, to an ounce of water 
was directed, to be applied after carefully syringing the ears 
out with clean tepid water three times a day. 

This treatment was continued with the use of a mild astrin- 
gent gargle, (the throat being slightly inflamed,) for three days, 
when my patient left the city for his residence, some eighty 
miles distant, in New Jersey, to return at the end of a week or 
ten days. 

On the 31st of August, he again called upon me, and I found 
the blistered surface healed. The discharge from the left ear 
had ceased, and the internal surface was dry and shining. The 
hearing distance had increased to four inches. 

The discharge from the right ear had diminished, but the 
process of destruction was evidently still going on. The hearing 
distance had however improved to about five inches. The 
blisters were re-applied with directions to add a small quantity 
of the ceratum cantharidum to the ordinary dressings, in order 
to keep up the irritation and discharge. The strength of the 
lotion was increased to six grains of the acetate of lead to the 
ounce, and the fluid extract of sarsaparilla, as prepared by 
Maris & Co., of this city, was directed to be taken in teaspoonful 
doses twice a day. The gargle to be continued — exercise in 
moderation to be taken, and to avoid coffee, and most of the 
unnecessary stimulants. On the 2d of September he left for 
his home, the hearing distance having increased to six inches 
in the left, and seven inches in the right ear. The discharge 
from the right ear almost nothing. 

Sept. 17th. — The hearing continues in the improved condition ; 
the discharge from right ear still to a small extent. The sul- 
phate of copper in solution was directed as a lotion. The 
etherial vapour was introduced a few times through the Eusta- 
chian tubes, with some small improvement in the sensibility 
of the nerves of audition. The ears were directed to be kejjt 



DISEASES OE THE MEATUS AUDITORIUS EXTERNUS. 67 

warm, and protected from dust and changes of temperature, by 
the use of wool in the auditory canal. 

On the 19th the patient left the city for his home, with the 
hearing improved in the right ear to ten inches, the discharge 
having entirely ceased; and in his left to something more. 
One year nearly has passed away and the improvement con- 
tinues, 

8. Foreign Bodies in tlie Meatus Auditorius Externus. — The 
frequency with which accidents of this kind occur in the practice 
of every physician, make them a matter of considerable import- 
ance. The bent form of the passage, with the great sensibility 
of the part, particularly when irritated and inflamed by the 
presence of a foreign body, present great difficulties in the 
way of its extraction. 

A collection of the ordinary cerumen of the canal, producing 
not unfrequently considerable deafness, and accompanied with 
various noises in the ear, may generally be brought away by 
means of the ordinary ear-scoop or curette, followed by the ju- 
dicious application of pure warm water. Water, according to 
the experiments of Hay garth, is the best solvent of the ear-wax, 
and ought, consequently, in all these cases to be used in pre- 
ference to the various oils and other substances sometimes 
recommended. 

When ants, caterpillars, spiders or other insects creep into 
the meatus, the introduction of a little olive oil will be proper, 
which will have the effect either to destroy them, or, by filling 
their spiracula, cause them to come out voluntarily. 

When dead, if small, they may easily be washed out with an 
ear-syninge and water. " For this purpose, the point of the 
syringe ought to be pressed gently against the edge of the mea- 
tus, so that it may occupy as little of the diameter of the tube as 
possible, and when the injection arrives at the membrana tym- 



05 THE HUMAN EAR. 

pani, the regurgitation will force the body upwards."* Should 
the insect, however, be too large for this, it may in most cases 
be taken out, without much trouble, by means of a pair of small 
forceps. 

The greatest difficulty will always be found in the extraction 
of more solid bodies, such as beans, peas, cherry-pits, pieces of 
glass, lead, iron, and similar substances. The evils which the 
protracted retention of such articles in the meatus entail, are 
inflammation of the lining membrane and neighbouring tissues 
— ulceration of the membrana tympani, destruction of the 
ossicula auris, and purulent discharges, involving the temporal 
bone itself, and even the membranes or substance of the brain. 

The following case reported by Fabricius Hildanus, and 
quoted by Samuel Cooper, will illustrate some extraordinary- 
symptoms resulting from this accident : 

" After four surgeons, who had been successively consulted, 
had in vain exerted all their industry to extract a bit of glass 
from the left ear of a young girl, the patient found herself 
abandoned to the most excruciating pain, which soon extended 
to all the side of the head, and which, after a considerable time, 
was followed by a paralysis of the left side, a dry cough, 
suppression of the menses, epileptic convulsions, and, at length, 
an atrophy of the left arm. She was cured by the extraction 
of the piece of glass, which had been in her ear eight years." 

Cherry-pits, grains of corn, beans and other substances, which 
expand on being exposed to the fluids of the part, in addition 
to the irritation induced by their presence, become embedded 
in the tissues, and in this condition are very difficult to remove. 
I have found it impossible to succeed with the forceps or other 
instruments ordinarily used, and the operation recommended by 
some of the old aurists ; of cutting down upon the meatus behind 

* Buchanan. 



DISEASES OF THE MEATUS ATJDITOKIUS EXTERNUS. 69 

the auricle, makes the matter no "better, and is consequently 
very properly entirely abandoned by the profession. 

I have been enabled, by means of an instrument used by 
dentists for the purpose of cleansing the cavities of decayed 
teeth, to extract cherry-pits and grains of corn, which had 
baffled the skill of some of our most eminent surgeons. The 
instrument is about four inches long, and will be sufficiently 
explained by reference to the accompanying cut. 

Jig. 6. 



The patient sits upon a chair, and an assistant supports his 
head, turned to one side, throwing, if possible, a strong light 
upon the ear affected. The instrument is carefully introduced, 
and pushed forwards until it reaches the substance, when, keep- 
ing the curved edge towards the axis of the meatus, it is rapidly 
passed beyond the body, between it and the wall of the pas- 
sage. As soon as this is done, the surgeon will find that he 
has complete control over it, and by traction can easily dislodge 
it from its bed. A repetition of the operation is much easier, 
both to the surgeon and the patient, and will in most cases be 
sufficient to extract the foreign body. 

The previous introduction of some bland oil, as recommended 
by Yelpeau, for the purpose of allaying irritation and causing 
the foreign substance to glide over the surface with greater 
facility, may be of use — but I have not found it of much 
importance. After the operation, the introduction into the 
meatus of some weak lead water may be necessary, or even the 
establishment of counter-irritation behind the ear or on the 
nape of the neck. 



CHAPTER III. 

DISEASES OP THE MEMBRANA TYMPANI. 

1. Acute Inflammation. — No period of life is exempt from 
this disease, but it is far more frequent in childhood and youth, 
than in adult life or old age. 

Symptoms. — A sudden pain in the ear, termed an ear-ache, 
with darting pains in the direction of the upper part of the 
throat, but no increase of pain on opening or closing the mouth. 
The pain which extends through the middle ear is deep seated 
and acute. These symptoms are frequently mistaken for ner- 
vous ear-ache, and i anodyne drops' are poured into the meatus, 
only to increase the agony of the patient. In mild cases the 
pain will cease when the patient experiences a free perspiration, 
which will take place in the morning, or towards morning, after 
a night of pain. On examination, in the latter case, the mem- 
brane is found moderately red and inflamed; but soon returns 
to its normal color and condition. In the more severe forms, 
the membrane presents a very red appearance, the vessels being 
large and filled with blood. The depression in the membrane 
disappears and suppuration sets in freely, producing an abun- 
dant purulent discharge. The consequences of the suppurative 
action may be arranged as follows, according to its intensity 
and duration : 1. Thickening and opacity of the membrane, 
being of a pearly white color. 2. Perforation in one or more 

(70) 



DISEASES OF THE MEMBRANA TYMPANI. 71 

points of the membrane. 8. Partial destruction, to the extent 
of one fourth, one third, or one half, leaving generally the 
manubrium of the malleus covered by a portion of the tissues. 
4. The malleus itself, or the incus and the orbiculare may be 
discharged through the meatus, but this is more generally the 
result of chronic inflammation of the parts, continuing for 
months or years. 

The duration of the milder forms of the disease, is not beyond 
a few days, sometimes a few hours. The consequent opacity 
of the membrane is slight, and soon disappears. In the severer 
forms, especially where any constitutional diathesis predisposes 
the tissues to destructive inflammatory action, several days or 
weeks may intervene before the disease is checked. The con- 
sequences are more serious in proportion to the intensity and 
duration of the inflammation. 

The sympathy between the ears, it is said, induces one to 
take on the disease on its subsidence : this however is doubtful. 
The causes which produced the first attack, continuing, will, of 
course, produce the second. 

The causes of this disease, are all those which produce 
inflammation elsewhere. Draughts of cold air, cold water, wet 
feet, the use of stimulating drops and injections, and other 
irritants designed to relieve some slight affection of the ear, 
perhaps. Indurated cerumen, never, perhaps, produces this 
disease. The prognosis is generally favorable, especially before 
suppuration sets in. Badly treated or neglected myringitis 
may extend to the middle or internal ear or brain ; but great 
carelessness alone would allow of this. The deafness which 
follows the disease, will of course be in proportion to the change 
which the parts have undergone. The orifices, however, pro- 
duced in the membrane by ulceration, when small, according 
to the testimony of some of the English Surgeons, will sometimes 
heal up spontaneously. If this be so, — and the writer has no 



72 THE HUMAN EAR. 

experience of his own to refer to on this head, except in 
cases of artificial perforation of the membrane — ,hopes may be 
entertained, that the hearing will improve gradually, even after 
this accident. Kramer and others of the continental surgeons 
do not give credence to this idea. The extreme facility with 
which these perforations heal when artificially produced, would 
lead us to suppose it quite possible after ulceration. 

Dr. Yearsley holds the following language in reference to 
this question. " With regard to the interesting question which 
has been so much debated, can loss of the membrane be repaired ? 
and to which the negative has commonly been given, one 
important distinction must be made as a preliminary to its 
consideration. We must distinguish between those cases in 
which from accidental causes, or the pressure of the matter, the 
membrane has been merely perforated without loss of substance, 
and others in which, from ulceration, the greater part of the 
membrane has been entirely destroyed. " 

Tn the first class of cases, I have no hesitation in declaring 
that nothing is more common than for the membrana tympani to 
cicatrise. Numbers of persons suffer in their childhood from 
suppuration of the tympanal cavity, and the exit of matter 
through the membrane, in which, in after life, no solution of 
continuity whatever can be discovered by the most searching 
examination, but in which there are evidences of cicatrisation. 
In the accidental forms of the affection, the drum frequently 
closes up perfectly within a few days after its perforation — 
(Braith. no. 18, p. 241.) 

Ulcerations, however, of the membrane, seldom occur at once, 
but are gradually developed, except in very severe cases, when 
the process here, as in other tissues, sets in rapidly, and destroys 
the parts in a short time. 

Diagnosis. — The ear should be carefully examined with a 
speculum, in a strong light, and should the passage be closed, 



DISEASES OF THE MEMBRANA TYMPANI. 73 

or partially closed by cerumen, it should be washed out with a 
sjainge and tepid water; provided the patient can, or will bear it 
— care being taken to do it gently. The membrane will be found 
either partially or entirely red, in proportion to the severity of 
the inflammation. There is now no difficulty in detecting the 
disease, ocular demonstration, placing it on the same footing as 
many other surgical diseases. 

Treatment. — In mild cases, a little bland olive or almond oil, 
poured or dropped into the meatus will assist in soothing the 
irritated and inflamed membrane. A few leeches behind the 
auricle, or below it, followed by a sinapism, or when the in- 
flammation is very painful, or has begun to suppurate, a fly 
blister over the mastoid process will be proper. 

General bleeding is very seldom indicated. A moderate 
cathartic or laxative may be, especially if the tongue be furred 
and the pulse strong. Pediluvia, with warm drinks, on retiring, 
after the action of the cathartic, will assist in determining action 
to the surface. The patient, as above stated, is relieved by 
free perspirations. In more severe cases, slight nausea, kept 
up, by the use of a solution of tartar emetic, for a day or two, 
will assist very much in reducing the inflammation. 

The head, according to Celsus — and it is good practice — 
should be elevated. The pain will sometimes be relieved in a 
very short time by fomentations (warm) of arnica flowers. For 
the rest, the treatment is the same, or nearly the same as that 
in acute inflammation of the dermoid tissue. Mild solutions of 
acetate of lead, either alone or with the acetate of morphia, will 
relieve the pain and reduce the inflammation in almost all stages 
of the disease. 

The form of the disease, associated with inflammation of the 
tympanal cavity, " sometimes of a rheumatic character/ 7 will 
of course be more persistent, and the rheumatic element will 
demand special attention. I must caution the young practitioner/ 

7 



74 THE HUMAN EAR. 

however, against a very common error, viz. considering all 
otalgias as rheumatic, and prescribing diaphoretic and anti- 
rheumatic remedies accordingly. 

Dr. Edward W. Clarke, of Boston, speaks of a form of the 
disease, which he denominates " subacute myringitis," and adds 
that it is a disease which comes on without any, or with very 
little pain; and is of " a most insidious character." " It comes 
on (says he) with little warning, progresses stealthily in its 
course, and in many cases no attention is paid to it, until organic 
changes have taken place, that are beyond the reach of treat- 
ment." He gives us but one case of this disease, which he 
fortunately was enabled to cure. The boy was seven years old, 
had had, " two years previous, scarlatina, — had light hair and 
eyes, and had four or five weeks previous to the attack of sub- 
acute myringitis, an attack of bronchitis. Easily caught cold 
in his ears, and had tenderness of the mucous surfaces of the 
nose, meatus and throat." A combination of circumstances, 
one would suppose, likely to induce a rapid derangement in the 
auditory organ, on the occurrence of any cause which would fix 
the disease. The truth is, the boy was scrofulous, and we all 
know that inflammations are always i insidious' in constitutions 
affected with this diathesis. The case should have been termed 
i strumous myringitis' — with nothing very insidious or peculiar 
about it. 

2. Chronic Inflammation of the Memhrana Tj/mpani, or 
Chronic Myringitis. — " This disease (says Dr. Clarke) appears 
as the result, or more properly speaking, the sequela of almost 
every form of aural inflammation. It is usually a painless 
disease. Sometimes, however, it is accompanied with attacks 
of severe pain, which are followed by intervals of entire ease. 
Tinnitus, which is often a most distressing accompaniment of 
nearly every disease of the ear, (?) is frequently altogether absent 
in this. It is always attended with deafness, which is perma- 



DISEASES OF THE MEMBRANA TYMPANI. 75 

nent, (and partial,) decided, and little affected by variations of 
temperature, changes of the seasons or mental emotions/ 7 We 
cannot coincide with Dr. C. in his reference to the effects of 
variations of temperature, and mental emotions on deafness. 
We have always found that both these circumstances materially 
affected the function of hearing in these cases. 

The disease is a very common one, much too common for the 
credit of our profession. True, a damp, variable climate, such 
as is found along our eastern or Atlantic border, in Boston, 
New York, Philadelphia, and perhaps Baltimore, doubtless 
causes the disease to be more frequent there, than in other 
higher, dryer, and more equable localities. Still, the general 
neglect of chronic affections of the ear, both on the part of the 
profession and of the people, should be enumerated among the 
causes of the greater prevalence of these diseases. 

Treatment. — The treatment of this form of inflammation, 
resolves itself, chiefly, into counter irritation and a course of 
alterative remedies. The local application of a solution of the 
acetate of lead, or a very mild (1 to 3 grains to the ounce) 
solution of nitrate of silver, may be necessary; but counter- 
irritation over the mastoid process, or on the back of the neck, 
or on the temples, or what is perhaps still better, the alternate 
application of blisters to each of these localities, as fast as one 
gets well of the irritation, will be proper. The irritation in 
any one place should be continued, until the discharge from 
the surface, shall be the same kind as that from the meatus. 
Calomel, iodine, iron, sarsaparilla, or other alteratives should be 
resorted to, and persevered in, according to the indications. 
Tonics of all kinds will be found useful, under different circum- 
stances. The iodide of potassium, in combination with the 
compound syrup of sarsaparilla, will be found a good alterative, 
given in the following form : 



76 THE HUMAN EAR. 

R. Syr, sarsa. co. f^iii. 
Potass, hydriod. gi. 
M. Take a tea spoonful three times a day, half an hour before 
meals, in a wineglass full of water. 

All stimulating drops and injections should be strictly for- 
bidden. Soft loose wool should be placed in the meatus, and 
every means taken to protect the inflamed surface from changes 
of temperature. Perseverance in this plan of treatment will 
generally prove successful, but the treatment must be continued 
for a length of time. 

According to Dr. Toynbee, the individual tissues of the 
membrana tympani ; may each be affected, without necessarily 
implicating the rest. The outer or epidermoid layer, for 
instance, is found in two diseased conditions. 1. It is hyper- 
trophied. 2. It is moderately thickened and " studded by 
numerous small round masses," adhering to the fibrous layer. 
The fibrous lamina, according to Dr. T., are of a double descrip- 
tion, circular and radiating ; forming two tunics, each of which 
is subject to disease, distinct from the other. " The external 
surface of the outer layer is frequently the seat of chronic 
inflammation. "When it becomes very thick and vascular ; and 
is covered by granulations of a deep red color ; polypi are also 
developed from it." Ulceration may destroy both layers and 
leave the internal or mucous layer untouched. This membrane 
will then " bulge inwards," falling upon the osicula. The 
fibrous layers are also the seat of calcareous deposits. 

" The diseases of the membrana tympani, in which all its 
component structures are at the same time affected, are the 
following : — 1. Hypertrophy, where the epidermoid, fibrous, 
and mucous layers are thickened. This not unfrequently pro- 
ceeds to so great an extent, that the membrana tympani is ten 
or even twenty times its natural thickness, and it becomes 



DISEASES OF THE MEMBRANA TYMPANI. 77 

opaque, hard and dense, like a piece of cartilage. — 2. Ulceration, 
where all the layers are destroyed, wholly, or in one part, so 
as to cause a perforation. — 3. An increase of the external con- 
cavity, so that its internal surface is in contact with the pro- 
montory with which it is frequently firmly adherent. — 4. An 
absence of the external concavity, in place of which it is perfectly 
flat. — 5. Scrofulous degeneration, in which all the layers lose 
their natural structure. 6. Calcareous degeneration, in which 
there is often not a vestige of healthy structure in any of the 
layers. 7. An increased degree of tension. This state is most 
frequently accompanied by the presence of membranous bands, 
which connect its inner surface to the promontory stapes, or 
other parts of the inner wall of- the tympanum. 8. Sometimes 
the whole of both fibrous coats are destroyed by ulceration, and 
the mucous layer remaining entire, falls inwards, and covers 
the surface of the promontory, and the inner wall of the tym- 
panum. 9. Sometimes one-half of the membrana tympani is 
destroyed, and the border of the remaining half becomes ad- 
herent to the inner wall of the tympanum, forming a closed 
cavity. 10. The entire substance of the membrana tympani is 
ruptured. The part most subject to rupture, is that between 
the posterior margin and the handle of the malleus." — Lancet, 
April 13, 1850, p. 455. 

Treatment of Ulceration of the Membrana Tympani. — When 
the ulceration is partial, the margins of the ulcers should be 
carefully touched with the sharp point of a stick of nitrate of 
silver, and the meatus protected with wool. Tonics and altera- 
tives especially, the alterative use of calomel will be found 
necessary. Fortunately the process of ulceration is not gener- 
ally very rapid, and time is thus afforded for a proper course 
cf treatment. It is found, also, not only that small perforations 
of the membrane will close, and that the opacity which neces- 
sarily accompanies and follows ulcerations of the membrane^ as 

7* 



78 THE HUMAN EAR. 

well as simple inflammations, without ulcerations, gradually 
disappears, especially in children and young persons. That 
the whole membrane, once lost, is ever restored, is scarcely to 
be credited; though cases of the kind are reported. 

Counter-irritation, in the way of blisters behind the ears, 
with lotions of acetate of lead, will of course be proper. The 
former should be continued until the inflammation has entirely 
subsided. Where the ulcers are clearly the result of scrofulous 
inflammation, sarsaparilla and the various salts of iodine will 
be proper, as in other similar cases. Care should be taken not 
to wet the head with cold water. 

4. In Hypertrophy, calcareous degeneration, &c, &c, it is 
well understood that the membrane is no longer capable of 
performing its functions. These conditions are the result of 
previous, generally chronic, disease. 

Treatment. — The treatment in these cases, except when the 
Eustachian tube is closed, together with the tympanum, or 
there is accompanying disease of some other kind, is to do 
nothing. The membrane, under these circumstances, has been 
perforated with the view of improving the hearing; but the 
operation of perforation of the membrane, can scarcely be justi- 
fiable for any morbid condition of its structure, alone. 

The questionable success of Sir A. Cooper, and others who 
have followed his example, has cast a doubt on the propriety 
of perforating this membrane in any case. Nevertheless the 
success attending some of the cases operated upon, not only by 
Sir. A. Cooper, but by Itard Mott, and others, justify us in the 
opinion of the author, m the performance of the operation in 
proper cases. 

Perforation of the Membrana Tympani. — A great number 
of instruments have been invented with which to perform this 
simple operation. The well known faet, that the perforation 
will soon heal up, if it be a mere perforation, without loss of 



DISEASES OF THE MEMBHANA TYMPANI. 79 

substance, induced the invention by Himly of a species of punch, 
analagous to that used by shoemakers. This takes a piece 
entirely out, and leaves a round orifice. Sir. A. Cooper and 
Saissy ; made use of a trocar. Buchanan, a quadrangular perfor- 
ator, and Deleau, a complex instrument, which is much approved 
of by Kramer. Itard used a stilet of tortoise-shell; and others 
have recommended the introduction of bougies, catgut or lead, 
in order to keep the perforation open. 

The author has used, with success, the ordinary tenotomy 
knife, considering, with Kramer, (p. 137,) that " it is always 
safest to operate with a simple instrument, that can be made to 
follow the movements of the patient." 

"We would prefer, however, most decidedly, especially in chil- 
dren, avoiding the necessity of u following the movements of 
the patient," and for this purpose have very successfully ether- 
ised the little patient. The complete quiesence produced by ether 
and chloroform, makes them invaluable in such delicate opera- 
tions; and we would respectfully repudiate, in toto, the practice 
of " strapping a patient's head to a stool," recommended by 
some authors. 

It is in fact almost impossible to fasten the head in a way 
that no motion can be effected by a struggling patient. The 
anethetic agents produce a degree of insensibility, which makes 
it equally impossible for patients to move. They are therefore 
to be preferred to any mechanical contrivance. The patient 
should lie on his side, with the ear to be operated upon, exposed 
to a full sun-light. The speculum will generally be necessary, 
in order to fully expose the membrane. The puncture should 
be made in the posterior inferior third. We here avoid the 
manubrium of the malleus, and have a larger field for the 
operation. Whatever instrument is used, a portion of the 
membrane should be fairly taken out. No after treatment is 
necessary. 



80 



THE HUMAN EAR. 



The earlier eases of punctured membrane, reported by Sir A. 
Cooper, were published in the philosophical transactions, for 
1802 — one of these is reported by Mr. J. C. Saunders, in his 
work on the ear, as " continuing to enjoy the relief he at first 
experienced/' in 1806. Itard has reported a number of favor- 
able cases. Deleau reports thirty-six cases operated upon, 
without success. 

Mercier reports a list of fifteen cases, in which the operation 
was performed. Six of these were performed for chronic 
thickening of the membrana tympani, and the remaining nine 
for obstruction of the Eustachian tube. One case alone, in 
which blood had been effused into the tympanum, was benefited 
by the operation. In this case, hearing was restored. — (London 
Lancet, 1845, p. 150.) 

In reference to the disposition of the membrane, to heal over 
a perforation, Mr. Saunders makes the following remarks. It 
has been found that its disposition to close is very great, even 
when the Eustachian tube is impervious, and this is still greater 
when the tube is open. 

Mr. S. adduces but one case, in which he had operated; it 
was that of a gentleman " who had been deaf for thirty years." 
" I placed him in the sun, (says he,) and passing a probe to the 
anterior part of the membrana tympani, made a small perfora- 
tion." A crack immediately ensued, and in the space of a few 
seconds, he heard distinctly the chirping of sparrows on a tree 
at a grea-t distance. The deafness returned at the end of a 
week. The operation was performed at intervals of two weeks, 
four times, and each time except the last, with the same effect. 

Kramer cites no cases of his own, in which he has performed 
the operation. 

Professor T. 1). Mutter, of the Jefferson College, writes as 
follows, in reference to the operation, in answer to a note from 
the author. 



DISEASES OF THE MEMBRANA TYMPANI. 81 

"Philadelphia, November 15, 1850. 
u Dear Sir : — In looking over my case book, I find that I have 
perforated the membrana tympani, in cases of obstructed Eus- 
tachian tube eight times. These operations were performed 
several years since, and were productive of no benefit whatever 
to my patients. I have abandoned the operation as one calcu- 
lated to do more harm than good. Yours &c. 

"Thos D. Mutter." 

On the other hand, my friend, Professor V. Mott, of New 
York, writes to me in the following manner, in reference to 
the operation : 

" New York, November 14, 1850. 

1 Dear Doctor : — As you kindly requested in yours of the 
11th inst. any and what my views and experience are in refer- 
ence to puncturing the membrana tympani in deafness ; I 
state with great pleasure the results of my experience on that 
subject. 

"I have a number of times punctured the membrane for 
imperfections of hearing, when I supposed it owing to a closure 
of the Eustachian tube, and with some manifest benefit fre- 
quently. In all cases in which there is a closure of this tube 
only, without a defect of any other part of the auditory apparatus, 
I think, philosophically and surgically, there is every justification 
for recommending and performing the operation. From some 
of the cases, in which I have tried it, being connected with 
something abnormal in the cavity of the tympanum or labyrinth, 
I feel as if I could account for the more or less partial success. 

In a case of perfect closure of the Eustachian tubes, on each 
side, from an extensive syphilitic ulceration of the throat, which 
had caused a most painful deafness for more than fifteen years, 
I saw the most wonderful restoration of hearing that can be 
imagined. 



82 THE HUMAN EAR. 

" It was in the person of an Irish gentleman of high classical 
attainments, and brilliant imagination and the effect of the 
puncture was most gratifying indeed. He could now hear 
conversation in the ordinary tone. His delight was extatic. 

" When the second was perforated, he sprang from the chair, 
ran around the room, and exclaimed in a wild and frantic 
manner, ( 1 hear, Iliear the wind rustling among the leaves — 
hark ! hark I — This/ said he, i I have not heard for nearly 
twenty years P Such thrilling delight I have never witnessed in 
any human being. 

" From his fine taste and glowing description of its effects, I 
requested him to give it me in writing, which he did. It was 
truly poetical and beautiful. 

u Yours truly, 

"Dr. Bryan/' "V. Mott. 

Professor Hamilton, of the Buffalo University, New York, 
writes me, that he thinks it (the operation) " a surgical resort 
of positive, but limited value. " 

The effect of the operation will be as complete immediately 
after its performance as at any time afterwards. 

Sir A. Cooper advocated a resort to this operation, in cases 
of closure of the Eustachian tube, or tympanum, without refer- 
ence to the condition of the membrane, except its being whole. 
Hypertrophy, and analagous changes of the membrane, are 
the only conditions admitted by Kramer, as proper for the 
operation. 

In a case of a boy five years old, mute, operated upon by the 
author in Geneva, New York, in 1849, the hearing was improved 
very much. From hearing nothing, except through solid bodies, 
he could hear his own name, when called from the opposite side 
of a room, with his face turned in another direction. Many 
other sounds were caught and recognised, but at the end of six 



DISEASES OF THE MEMBRANA TYMPANT. 83 

weeks the improvement gradually disappeared, and he returned 
to his former condition. There appeared to be some thickening 
of the membranes in this case, they were both perforated and 
chloroform was used to keep him quiet. An ordinary tenotomy 
knife was used in the operation, and a free opening made by 
turning the knife on its axis several times. The orifices, how- 
ever, doubtless closed at the end of the six weeks. 

Deafness with Perforation of the Membrana Tympani. — The 
announcement of Mr. Yearsly of his treatment of these cases, 
excited considerable attention in the mind of the medical faculty 
of England. The introduction of moistened wool or cotton into 
the meatus in contact with the membrane, was followed by an 
almost miraculous restoration to hearing ; and hundreds, perhaps 
thousands of cases were, soon after the publication of Mr. Y.'s 
paper, treated in the London hospitals and dispensaries in this 
way. According to Dr. TYakley, however, the good effects 
ceased on the wool becoming dry. The patient's disappointment, 
after his sudden restoration to hearing, was extreme on finding 
it entirely gone again; and resort was again had to the surgeon, 
who produced the same effect,' by placing moist wool or cotton 
in the ears, as before. "Dr. W., therefore/' says he, "looked 
for something that would retain moisture in the ear, and fell 
upon glycerine." 

He reports ten cases, treated by the latter article, in the 
London Lancet of 1849 — nine of whom were females. In none 
of these does he state the hearing distance by the watch, or the 
conditions of the Eustachian tube. He reports the membrana 
tympani, not perforated but thickened, or generally sound. 
The ceruminous secretion of the meatus was generally deficient. 
One patient was in the habit of improving his hearing by putting 
water in his ears. 

The whole report is entirely too indefinite to be relied on 
in practice. That glycerine " is good for deafness," is the 



84 THE HUMAN EAR. 

language of a newspaper advertisement, and not that of a 
scientific medical journal. Several of the above cases were 
benefited only while the glycerine was used; and Dr. W. 
thought the patients would be obliged to use it always. Dr. 
Yearsly used the wetted cotton in cases of perforated membrane ; 
and directed the cotton to be placed against a certain point of 
the membrane or the benefit expected would not follow. "What 
or where this point is, he does not tell us. The last cases 
reported in which glycerine was useful, were cases purely of 
dry ears, where a scaly eruption which covered, the lining 
of the meatus was softened and thrown off, and the natural 
secretion restored. The writer has thus come round to the 
ordinary domestic notion of a "lack of ear-wax. " All this 
proves that we do not yet know in what conditions of the meatus 
the glycerine is useful. 

5. Tension and Relaxation of the Membrana Tympani. — 
These conditions of the membrane are, according to Dr. Toynbee 
dependent upon charges in the tympanum, or in the membrane 
itself. Their existence, however, in whole membranes may 
perhaps be earnestly doubted. Certainly it is very difficult to 
detect them. We will therefore pass them by. 



CHAPTER IV. 



DISEASES OF THE MIDDLE EAR. 



The great stress laid upon a proper exploration of the middle 
ear, in all inter aural diseases, by Kramer and other more 
modern writers, is doubtless founded in truth. 

Reports of almost any important affections of the ear, with a 
statement of the result of a proper exploration, through the 
Eustachian tube, are generally unsatisfactory. 

The hearing distance, the anormal sounds, with any or all 
accompanying symptoms, should of course be fairly stated ; but 
these are very frequently insufficient without a knowledge of 
the condition of the middle ear, to be obtained alone by explora- 
tions of some kind, through the pharyngeal tube. The simplest 
means of examining the permeability of the tube and drum, is 
to direct the patient to close his mouth tightly, and press his 
nostrils together with his fingers; then attempt to blow or 
exhale forcibly. A sensation of fulness and of crackling will 
be experienced in one or both ears, if the passage be pervious. 
This is secured by the distension of the membrana tympani by 
the pressure of the air. Some little practice is generally 
necessary, before persons fully understand the process and object 
of this experiment ; and if the surgeon be not careful he may 
be deceived by the representations of the patient. 

8 (85) 



86 THE HUMAN EAR. 

The next process is that of catheterism. This is done by 
introducing the ear catheter, through the nose, into the cavity 
of the fauces and posterior nases \ causing the end of the in- 
strument to enter the pharyngeal extremity of the Eustachian 
tube. The air press, the breath forcibly expired with the passage 
catgut, or whale-bone, passed through the catheter and tube are 
the ordinary means of exploring the parts. These processes, 
are mostly diagnostic only, and not curative; though cases not 
unfrequently occur where they are really curative. The best 
catheter to be used for this purpose is, perhaps, one intermediate 
between that of Kramer and that of Pilcher. Another moderate 
curve added to Kramer's appears absolutely necessary to its 
introduction in many cases. The shape of the nasal passage is 
frequently, from the position of the lower turbinated bone, the 
oblique position of the former, or other malposition of parts, 
very tortuous, and many cases occur, even in adults, where it is 
impossible to introduce his catheter. 

The cut {jig. 6) represents one calculated to meet these con- 
ditions. Several sizes should however be kept on hand. 

The instrument should be made of the same temperature as 
the body, the point pressed suddenly on the floor of the anterior 
nases, and slid gently along that surface, with the convex surface 
upwards, until it reaches the posterior wall of the fauces. It is 
now gently retracted for about half an inch, and the point turned 
upwards and outwards, and pushed backwards until it again 
reaches the back wall of the fauces. The point thus enters the 
oblique step of the Eustachian tube, and appears moderately 
fixed. It may be retained in situ, by the hand of an assistant, 
or a band properly placed around the forehead, with a metallic 
or wooden handle, which may be fastened to the external ring 
of the catheter. The patient soon learns to press upon and 
retain the instrument in its place, during the manipulations 
necessary in exploring the tube. Blowing with the mouth 



DISEASES OF TIIE MIDDLE EAR. 
Tig. 6. 



87 




The cut no 6, will explain the mode of introducing the catheter, and exhibit the shape 
of the instrument. 1. Mouth of the Eustachian tube in the upper and back part of the 
throat. — 2. Catheter, five and a half inches long introduced through the nose, with one 
end in the mouth of theEustachian tube at No. 1. — 3. Perpendicular section of the tongue. 
— 4. Inferior turbinated bone, which, with the bent bone, often obstructs the passage 
of Kramer's catheter. These are avoided by the bent form of this catheter. — 5. Proximal 
extremity of the catheter, with a ring, which in the introduction of the instrument should 
be made to turn outwards towards the external angle of the eye, as it corresponds to 
the direction of the bent point of the distal extremity. — 6. Free distal extremity. 



88 



THE HUMAN EAR. 



through the catheter, the air press, (Jig. 7,) turned on it, or a 
piece of cat-gut, or whale-bone, introduced and passed through 
the catheter into the tube, are the usual means of exploration. 

Fig. 7. 




Having premised these remarks, we now pass on to the dis- 
eases of the middle ear, and first : 

1. Acute Inflammation of the Tympanum. — The mucous 
membrane of the tympanum is not unfrequently inflamed, by 
continuous sympathy acting through the Eustachian tube, from 
the pharynx and neighbouring surfaces ; but there is, according 
to the best authors and ordinary professional observation, an in- 
flammation which may with propriety be denominated idiopathic. 

" The symptoms produced by inflammation of the tympanum, 
are most intense pain in the ear and head, a great degree of 
symptomatic fever, and sometimes slight delirium. The pain 
fluctuates, and its paroxysms resemble the tooth-ache. This 
resemblance has unfortunately caused it to be wholly neglected, 



DISEASES OF THE MIDDLE EAR. 89 

or very improperly treated. The case obviously requires the 
most active antiphlogistic treatment, and the absence of every 
thing stimulative." (Saunders, p. 57.) 

The local pain and general febrile symptoms continue until 
suppuration has set in ; generally ulceration of the membrana 
tympani follows, and a purulent discharge through the external 
meatus. Dr. Saunders speaks of this as a matter of course, and 
does not notice a similar discharge from the Eustachian tube. 
The latter however may be the only one, and the suppurative 
process, instead of involving the mastoid cells and meatus 
auditorius externus, may be entirely confined to the interior of 
the tympanum and Eustachian tube. 

Eelief from the great pain and other urgent symptoms gener- 
ally follows the rupture of the membrane and a free purulent 
discharge. Great care should be taken not to confound this 
disease with otalgia or common nervous ear-ache. A somewhat 
intermittent character may mislead into the belief that it is 
purely nervous. A very great mistake would doubtless follow 
in the treatment. Indeed almost all the best modern authors, 
deplore this mistake so very common in practice. The mastoid 
cells being affected, ulceration may perforate their walls behind 
the auricle, and a purulent discharge from these bony cells may 
continue for a long time, particularly when a strumous or other 
morbid diathesis, so diminishes the vital and nutritive forces 
as to prevent the early healing of the inflammation. 

The consequences of this disease when not checked early in 
its course may be — 1. Perforation of the membrana tympani ; 
2. losening and destruction of the bones of the tympanum; 3. 
fistulous openings, one or more, through the mastoid process; 

4. closure of the Eustachian tube or filling up of tympanum ; 

5. permanent disease of the petrous portion of the temporal 
bone ; 6. Inflammation of the dura mater or brain, or both, 
followed by convulsions and death. Lastly, deafness is a very 



90 THE HUMAN EAR. 

common result, even should the membrana tympani escape the 
ulcerative process, and remain whole. It may be thickened 
and hypertrophied, or otherwise affected, so as to materially 
derange its functions. 

"When the inflammation has been slight, or has been reduced 
early, the Eustachian tube, or tympanum, may have " mucous 
engorgement/' or one or more strictures may be formed in this 
canal, or it may be partially or entirely obliterated. The 
thickening of the lining membrane may result in this. Lymph 
thrown out in the tympanum may become organized, or partially 
organized, and a closure of the whole cavity may be the conse- 
quences : most commonly, however, as has been stated above, 
a freer suppuration follows the active stage of the inflammation, 
and a purulent discharge takes place. 

Treatment. — When the case has been clearly made out, the 
treatment is very manifest. Antiphlogistics, such as bleeding 
cathartics, leeches followed by blisters behind the ear, and 
emolient poultices to the auricle and meatus. Bland unirrita- 
ting applications to the meatus, rest, the ear and head elevated, 
with the use of remedies calculated to determine towards the 
skin, should be resorted to. 

In plethoric patients, with a strong pulse, bleeding from the 
arm, followed by pediluvia and senna and salini cathartics. 
To the latter, should be added small quantities of tartar emetic, 
for the double purpose of increasing their efficiency and indu- 
cing a determination to the skin. 

Dr. Saunders seems to think that the perforation of the 
membrana tympani, by the ulcerative process, is a necessary 
result of suppurative action in the tympanum ; and says, u But, 
let it be admitted that the tympanum has suppurated. Ought 
the membrana tympani to be abandoned to a casual ulceration, 
or is it better to open it by art ? I am inclined to prefer the 
latter ; and if I could be assured by any symptom that suppura- 



DISEASES OF THE MIDDLE EAR. 91 

tion has taken place, I should not hesitate to make a small 
perforation of the membrana tympani; and to repeat it, if 
necessary, taking at the same time every precaution to suppress 
the fresh collection of matter." (p. 59.) 

We do not agree with this distinguished author in this 
remark, knowing that the Eustachian tube is the natural outlet 
of the tympanum and will probably act as such in this instance. 
A fortiori, this, in our estimation, must be the case where proper 
treatment has been instituted early in the course of the disease. 

To encourage the passage of the pus through the Eustachian 
tube, Itard and others have recommended the use of gargles, 
and the catheter, or air blown into the passage, by the patient 
himself. These means may sometimes be useful, and should 
not be neglected. The application of a strong solution of nitrate 
of silver, (40 grains to the ounce of water,) will be found 
effectual in reducing inflammatory actions in the throat and at 
the mouth of the tube. This should be applied by means of a 
piece of sponge tied to the end of a piece of whale-bone. Where 
a strumous diathesis exists, or the case is neglected or improperly 
treated, disease is very liable to run on into the chronic form, 
and it is then termed chronic inflammation of the tympanum, 
or simple chronic internal otorrhea. The disease known under 
this title may have originated in the tympanum, Eustachian 
tube or throat, or it may have passed from the external meatus, 
and especially the membrana tympani, to the tympanum. 

In the latter case the membrane is of course either partially 
or entirely destroyed. (See diseases of membrana tympani and 
chronic otorrhea.) The chronic is distinguished from the acute 
form of the disease, by being accompanied with much less pain, 
sometimes none at all : hence by some writers the designation 
both in this and other cases of sub-acute inflammation. This 
designation is objectionable, inasmuch as it is founded chiefly 
on the absence or less urgent character of but one symptom — 



92 THE HUMAN EAR. 

pain. Now it is well known that this symptom varies very 
much in the different tissues affected with inflammation, whether 
the inflammation be acute or chronic. In some tissues the pain 
is almost none ; in* others it is very acute, and altogether dis- 
proportioned to the organic changes taking place. We therefore 
object altogether to the terms sub-acute, and prefer retaining 
the ancient division of acute and chronic, inasmuch as sufficient 
latitude is given in their definition for all practical purposes. It 
will be remembered also, that temperament, diathesis, and the 
condition of the system at large, at the time of an attack of 
inflammation, modify its effects and symptoms. In delicate 
structures like those of the ear, brain, &c, the 'insidious,' 
character of chronic inflammation must of course be understood 
and guarded against. 

It is impossible in practice to retain entirely the subdivisions 
of this disease, according to the tissue or tissues implicated. 
The mucous membrane may long be the seat of a chronic in- 
flammation, whose effusions of serum, pus, or perhaps sometimes 
blood, — will find their exit through the Eustachian tube, or 
through the external meatus, or both. 

This tissue may also become thickened and close the small 
tube of Eustachius, or there may be simply mucous engorge- 
ment of the tube or the tympanum, or both. In other cases, 
one or more strictures may be the result of inflammation of the 
mucous membrane of the tube. When the cause of the disease 
is some inflammation exterior to the parts, sore throat, measles, 
scarlet or other fevers, these conditions are often the sequelae, 
and the patient finds some time after the subsidence of the 
fever, that the hearing is dull, on account of the temporary 
closure of the Eustachian tube. This however in many cases 
opens itself by discharging the mucus, more or less inspissated, 
into the throat. A species of plug, is in this way thrown off as 
soon as the surface of the membrane becomes covered by its 



DISEASES OE THE MIDDLE EAR. 93 

ordinary healthy secretion. The process as will be seen, may 
be facilitated by the air press, or the introduction of a properly 
constructed bougie, through the ear catheter. 

Morbid productions in the form of polypi, and other fleshy 
developments, may also grow from the surface of the mucous 
membrane. These may close the internal orifice of the external 
meatus, and obstruct the exit in this direction of the pus, 
which in these cases is commonly thrown off in large quantities. 
As the membrane lines also the mastoid cells, inflammatory 
action may be communicated there, and passing through the lining 
membrane to the osseous and other structures, form fistulous 
orifices behind the ear. 

The sub-mucous cellular tissue of the tympanum will of 
course be affected in chronic, as well as acute inflammation of 
the parts. The inflammation will however pass rapidly on to 
the periosteum, and even to the bone, particularly that of the 
oscicula and the small bones themselves. These latter become 
loosened, and force their way out through the external meatus. 
When the bone of the tympanum becomes affected, the dura 
mater, covering the petrous portion of the temporal bone, will 
become diseased, and the affection pass on in many cases to the 
brain itself, producing severe cerebral disturbances and death. 
In all forms of the chronic affection of the tympanum there is 
danger at any time, from exposure to cold and the other causes 
of inflammation, that the disease will assume the acute form, 
and pass rapidly to the membranes, or to the brain itself. This 
should be a strong inducement to try fairly, and for a length of 
time, all rational means of cure. (See Otorrhea.) 

The great symptoms of this disease are deafness and a purulent 
discharge, — the latter being not unfrequently very foetid, espe- 
cially when the osseous structures are involved. 

2. Scrofulous Chronic " Otitis Interna" presents, in addition 
to the other symptoms of the disease, those of the scrofulous dia- 



94 THE HUMAN EAR. 

thesis, and is much more formidable in its consequences. It 
differs also in its treatment from the simple. 

This form of the disease is one most common before the 
patient is seven or ten years of age. It is, in fact, found most 
frequently in childhood. The ordinary neglect of chronic, and 
even acute inflammations of the ear in children, so much deplored 
by Saunders and others, (see chronic otorrhea,) results in the 
complete establishment of this disease, and it may continue for 
many years. Whereas the strong disposition of the human 
system to throw off the scrofulous diathesis anterior to the 
period of puberty, is very favorable to obtaining a cure of 
chronic otorrhea, internal or external, before the disease becomes 
what may, with some degree of propriety, be denominated con- 
stitutional. The usual alterative remedies, with change of air, 
diet, location, habits, occupations, &c, must be resorted to in 
order to be successful. Generally the disease will yield, in 
children, under the use of a good vegetable diet, as indian corn, 
rice, sugar, &c, with occasionally small quantities of fresh, 
easily digested, lean animal food. The use of salt baths, sea 
bathing, and, internally, Saratoga, Virginia springs, or other 
mineral waters, will assist in supplyin g the system with elements, 
— the absence of which constitutes the diathesis. 

Counter irritation, judiciously applied, will almost always be 
found useful. Blisters "behind the ears," allowed to heal 
occasionally, and then repeated, will be a very good mode of 
keeping it up. On the back of the neck, or arm, or shoulder, 
the same means may be resorted to, or better a seton or issue 
may be applied. The use of the tartar emetic ointment over the 
mastoid process is recommended by some ; but the fact that pus- 
tules are accompanied with ulceration, and leave, consequently, 
unseemly marks, forms a decided objection to its use. A more 
moderate irritation and eruption can be obtained by the use of 
croton oil, either placed on the skin, by pouring a single drop 



DISEASES OF THE MIDDLE EAR. 95 

upon the point of the finger, and rubbing it on the part, or 
using it in the form of an ointment. The proportion which 
will be found effectual, is about one part of the oil to three 
parts of simple cerate. A liniment made in the same propor- 
tions, with oil of turpentine, olive oil, or soap liniment may be 
used to produce a moderate pustulation. 

3. Mucous Engorgement of the Eustachian Tube and Tym- 
panum. — This condition of the ear is characterized by a sense 
of fulness, and stoppage of the ears, as though a veil were thrown 
across the ear. Sometimes there is tinnitus, and various unusual 
sounds are heard. At other times nothing but a persistent 
dulness in the function of hearing, modified by the different 
conditions of the air on the system at large. In dull, wet 
weather, the deafness is often increased, as anything like a 
'cold' is sure to increase the deafness. Free perspiration in 
bed, or after active exercise, .or a free mucous discharge from 
the mucous membrane of the throat, will generally be followed 
by an improvement in hearing. Melancholy and other de- 
pressing passions increase the deafness, while excitement, espe- 
cially that which is pleasurable, often improves it. 

The deafness may either increase slowly or rapidly, and ter- 
minate in the total loss of hearing, or after a gradual diminution 
it may become stationary, and get no worse during the rest 
of life. 

Causes. — A mild form of this disease will be found not un- 
frequently to exist after several of the eruptive fevers, particu- 
larly measles, scarlet fever, or varioloid. These not unfrequently 
get well spontaneously, and the patient feels a sudden cracking 
in his ear, and the hearing returns gradually. In some cases 
the deafness will continue in one ear, and little attention will 
be given until the function of that ear has been very much 
deteriorated. Sore throats, enlarged tonsils, or a disposition to 
irritation and inflammation of the mucous membrane of the 



96 THE HUMAN EAR. 

mouth, fauces, throat, and air passages, may be laid down 
among the most common causes. Above all, however, a scrofu- 
lous diathesis is the most common accompaniment and cause of 
the disease. In this diathesis, it is well known the tonsils are 
very liable to inflammation, acute and chronic, as well as en- 
largements; the latter condition, associated with deafness, has 
led some respectable aural surgeons to place it in the position 
of a cause of deafness, acting mechanically by closing the 
Eustachian tube. They accordingly recommend the extirpa- 
tion of the tonsils, with the use of remedies, to diminish the 
swelling and inflammation of the neighboring mucous membrane. 

The author has little experience in the matter, and can 
point to but few cases, where the excision of the tonsils has 
resulted, even when other measures were resorted to, in reduc- 
ing the inflammatory condition of the mucous surfaces, or the 
restoration of hearing. 

Treatment. — If the deafness be clearly made out, the treat- 
ment to be resorted to in these cases is clear. It is to remove 
the mucous obstruction, and to alter the condition of the lining 
membrane, so as to prevent the recurrence of the disease. Some- 
times a voluntary, but forcible expulsion of the air by the 
patient, through the meatus, will relieve him, especially in 
slight and recent cases. Lentin, according to Kramer, recom- 
mends the patient's head to be placed on a table, " fills the 
diseased ear with water, and then directs the patient to expire 
forcibly, with the mouth and nose closed, and observes whether 
the water in the ear moves or not. If the latter be the case, 
he concludes that the Eustachian tube is closed." (Kramer, 
p. 171, first edition by Bennett.) A better mode than this, as 
a means of exploration, is, doubtless, to drive in the air in 
the same way, and place opposite the ear a lighted candle. 
The motion of the flame will indicate whether a current 
of air pass through the membrana tympani or not. Better 



DISEASES OF THE MIDDLE EAR. 97 

perhaps than this, is the plan of filling the mouth and throat 
with the smoke of a cigar, and expelling it, if possible, through 
the meatus in the same way, this will be quite visible to the 
eye of the surgeon, as it flows through the external meatus. 
These means, however, must mostly be considered as diagnostic 
only, not curative. 

The use of the air-press, applied in the usual way, is of the 
first importance. " On making the attempt," the air either 
does not enter at all, or only with considerable effort, and ac- 
companied by a gurgling noise in the middle meatus. 

The application of the ear of the surgeon to the side of the 
face of the patient is sufficient, generally, to enable him to 
detect this " gurgling noise" of the air, passing directly to the 
membrana tympani ; but he will find it very convenient to use 
the otoscope, (an elastic tube, twenty inches long, with each end 
tipped with ebony,) one end of which is placed in the external 
meatus of the patient, and the other in that of the surgeon. 
The introduction of air in this manner, is followed by a pleasant 
sensation of relief to the patient, a diminution of the tinnitus, 
and an immediate improvement in the function of hearing. 
The latter may be easily detected by the watch applied near 
the patient's ear. 

When no gurgling noise is heard, and no amelioration in 
hearing at the first sitting, it may gradually occur after two, 
three, or four sittings. But if, after four sittings, no benefit 
result, the disease must be considered as consisting in stricture, 
or obliteration of the Eustachian tube. (Kramer.) 

Sometimes, when there is a strong tendency to mucous en- 
gorgement, partial relief will be followed by a relapse, especially 
on the occurrence of a cold, or other inflammation of the vici- 
nity. The tendency in scrofulous subjects, with large tonsils, 
thickened velse palati, and a general puffyness of the mucous 
membrane of the throat and nasal cavities, is to a recurrence 

9 



98 THE HUMAN EAR. 

of the disease, even when the relief from the simple process 
above stated, has been entire. In these individuals, a course 
of iodine treatment, the use of alum gurgles, with the ap- 
plication of the strong solution of the nitrate of silver to the 
fauces, (40 to 60 grains to the ounce of water,) washing the 
neck every morning with cold water, and rubbing it after- 
wards with a coarse towel, until the skin is red, regular and 
vigorous daily exercise in the open air, &c, will be necessary 
and proper. 

The compound syrup of sarsaparilla, with the pottasii iodi- 
dum ; should be freely resorted to, with decoctions of sarsapa- 
rilla, tincture, and other preparations of the guaiacum; and in 
young children, in whom, by the by, the disease is most com- 
mon, a resort to some of the preparations of iron, — the best of 
which is the precipitated carbonate, — this, combined with pow- 
dered ginger and rhubarb, will be found a most excellent alter- 
ative in young scrofulous subjects. 

The air-press should again be resorted to, after a fair trial 
of a course of eutrophics. Where secondary syphilis is the 
accompanying disease, the appropriate treatment for this, 
should be resorted to, especially a mild salivation, or the judi- 
cious use of the bi-chloride, followed in each case by sarsa- 
parilla, or guaiacum. Little hope can be entertained should the 
complication be tertiary syphilis. Here, however, as in scrof- 
ula, we must resort to the various preparations of iodine. 

In cases of deafness, after scarlet fever and measles, Dr. 
N. Morris, of the New York institution for the deaf and dumb, 
found the tube filled with mucous, the lining membrane red, 
and large veins running through it, and sometimes a preter- 
natural dryness, both of the middle ear and the external 
meatus. (Annual Report for 1847.) M. Petriquin, reported 
some ten cases of deafness in old people, and others, from 
obstruction of the Eustachian tube, dependent, as he thinks it 



DISEASES OF THE MIDDLE EAR. 99 

generally is, on engorgement of the mucous membrane of the 
throat, cured by the use of the solid alum, applied to the 
fauces, with inflation. A very favorable report was made on 
the subject before the medical society of Lyons, by Brechet. 
The alum is also used in solution and powder. (Braithwaite, 
No. Ill, p 112, 1841.) 

Stricture of the Eustachian Tube. — This may exist, either 
in the outer or inner half of the tube ; and may be, as in the 
urethra, single, or there may be two, or more. The test here, 
is the air-press, or air blown in from the mouth of the surgeon. 
Should the air not pass into the tympanum, or pass imperfectly, 
(the latter will be known, by the sound being small and low, 
instead of crackling and rattling,) we have reason to believe 
there is a stricture. The air-press should be applied two, 
three, or four times, and then a piece of violin catgut, of the 
string A or C, should be cut a little over the length of the cathe- 
ter ; and then pushed about one inch beyond the point, and a 
mark with a pen and ink, made at each point, at the proximal 
end of the catheter. In this way, we have a black mark on 
the catgut, representing the length of the catheter, and indica- 
ting, consequently, when the point of the string reaches the 
mouth of the Eustachian tube, when pushed gently through 
the catheter; the second mark, one inch beyond, will indicate 
the distance the string has been introduced into the tube, when 
properly and carefully pressed forwards. The length of the 
tube being about one inch, the string should not be introduced 
further. 

The mode of introduction is simple. The patient is made 
to sit upon a chair, in the usual way, for the introduction of 
the catheter : the latter is carefully made to enter the nose and 
opening of the Eustachian tube, and is then sustained in its 
place by a proper apparatus, or the hand of the patient. The 



100 THE HUMAN EAR. 

catgut, marked as above, is softened at the end by biting it 
with the teeth and moistening it with the saliva, then introduced 
to the end of the catheter. Gentle pressure will be necessary 
to cause it to pass into the Eustachian tube ; and when it has 
passed the extent of an inch, a quick sharp pain will be expe- 
rienced by the patient, as the point of the string touches the 
internal surface of the membrana tympani. The string will 
sometimes not pass easily, but move on, by pushing it a little, 
and go beyond the mark upon it. In this case, it will be 
found to have passed downwards into the throat, and the 
patient will feel it, and complain of its tickling him. 

Care should be taken to keep the catheter steady during the 
introduction of the string. If the string pass freely into the 
tympanum, the effect will be an immediate amelioration of the 
function of hearing; though this may not continue. In the 
latter case, we are to expand or dilate the stricture, by allowing 
the catgut to remain in the passage. For this purpose, the 
outer extremity should be made fast to the skin of the face by 
means of a piece of adhesive plaster. The fluids of the tube 
will expand the string, and a gradual dilatation of the stricture 
will be the result. This process may be repeated several 
times. The other indications are to be met, of course, at the 
same time, and in the usual modes. 

The use of silver or other wires, instead of the catgut, as 
dilators of the stricture, is to be reprobated. The catgut is 
safe, and they are not. It will be found necessary to resort at 
first, to small strings, and to increase the size from day to day, 
as the dilatation progresses. 

4. Impervious Eustachian Tide. — In some cases, the above 
means of exploration will fail to indicate, or secure a passage 
to the middle ear : and the painful fact will become obvious, 
that the tube is impervious. A temporary closure, from mucous 



DISEASES OF THE MIDDLE EAR. 101 

or other fluids should be treated as above : but in old cases, 
where all the usual means fail to indicate a passage, or to make 
one, the prognosis is clear, and no assistance can be afforded 
by art. The effect of a permanent closure of this tube on the 
hearing, is to impair very much the function, and finally, often 
to destroy it altogether. No means, therefore, should be neg- 
lected, calculated either to open the passage, or to fix definitely 
the fact, that it is permanently closed. When the closure 
exists only in one ear only, we may expect that the function of 
the other ear, so far from being affected unfavorably, will 
become more acute. 

From some pretty well attested facts, and observations, ifc 
would appear, that a loss of this passage is followed by a 
greater deficiency in the function of hearing, than the loss or 
closure of the external meatus above. Cases are reported of 
the congenital absence of the auricle, and closure of the exter- 
nal meatus, in which the individual could hear tolerably well by 
opening his mouth ; and it is well known that in paying close 
attention to indistinct, or distant sounds, the mouth is instinc- 
tively opened. " The Rev. B. H. Benton, in a letter to the 
London (Va.) Chronicle, says, " strange, but not less true, I 
yesterday, saw a colored woman without ears ; not only was 
she without the auricle or external part of the ear, but there is 
no trace of a foramen, or passage for sonorous vibration. The 
meatus is entirely closed, yet she can converse with others, and 
distinctly hear their words, for which purpose she opens her 
mouth" (1850.) "The woman belongs to Mr. James Broad- 
dus, near Caroline court-house." 

Professor R. D. Mussey reports a similar case in the Amer. 
Jour. Med. Sciences, vol. xx., p. 537, 1837. 

The following " Pathological Sequences of Acute Inflamma- 
tion of the Fibro-mucous Structures of the Cavity of the Tym- 
panum," as published by James Mercer, M. D., F. R. C. S. E., 

9* 



102 THE HUMAN EAR. 

lecturer at Edinburgh, will show some of the pathological condi- 
tions not unfrequently connected with, and induced by, acute 
and chronic tympanitis. The sections are accompanied, and 
the subjects illustrated by numerous cases, taken from medical 
journals and standard works on diseases of the brain. They 
will exhibit more forcibly than a simple general statement of 
the fact, the dangers connected with both chronic and acute 
affections of the middle ear. 

u Section 1. Caries of the parietes of the tympanum, produc- 
ing meningitis, without destruction of the petrous portion of 
the temporal bone. 

"Section 2. Caries of the parietes of the tympanum, pro- 
ducing meningitis or cerebritis, in consequence of destruc- 
tion of the osseous septum between its cavity and that of the 
cranium. 

" Section 3. Caries of the parietes of the tympanum, inducing 
phlebitis of the lateral sinus and internal jugular vein. 

" Section 4. Caries of the parietes of the tympanum ; necrosis 
of the petrous portion of the temporal bone; destruction of the 
portio dura, in the aqueductus fallepii, producing paralysis of 
the muscles of the face. 

" Section 5. Caries of the parietes of the tympanum; necrosis 
of the petrous portion of the temporal bone; destruction of 
the gasserian ganglion, producing paralysis of sensation in one 
half of the face and mouth. 

16 Section 6. Caries of the parietes of the tympanum ; necrosis 
of the petrous portion of the temporal bone ; opening of the 
internal carotid artery in its canal of the temporal bone } either 
alone or in conjunction with the lateral sinus, or the destruc- 
tion of the gasserian ganglion or the facial nerves." {Monthly 
Journal^) 

From all that has been said, it will be seen, that the inflam- 
mations of the tympanum, whether acute, chronic, or specific, 



DISEASES OF THE MIDDLE EAR. 103 

are at once dangerous and difficult to cure. The almost neces- 
sary rupture of the membrana tympani, or perforation of the 
mastoid cells, shows that the disease is likely to make inroads 
upon the neighboring tissues. The treatment, consequently, 
must be, in the acute form of the affections, prompt and deci- 
ded. Venesection leeches, cathartics, and a low diet will be 
found necessary and useful. When the throbbing pain, and 
the general character of the symptoms indicate that suppuration 
is taking place, it should be encouraged by emollient poultices, 
fomentations, &c, and when there is a pointing in the region 
of the mastoid cells, free incisions to the bone should be made. 
These may sometimes be followed by injections of tepid water 
into the tympanum, which will, in some cases, be evacuated into 
the fauces, through the Eustachian tube. There may be cases, 
when relief would be obtained in the early, though suppurative 
stage of the disease, in perforating the membrana tympani; 
but generally, this fragile membrane is soon broken by the in- 
flammation attacking it on the internal surface. 

In the chronic form, pieces of bone from the mastoid process, 
the small bones of the ear, &c, will be discharged from time 
to time. 

Topical treatment is in these cases very important to protect 
the brain and its membranes. The following case, taken from 
several others in my day-book, will illustrate the chronic form, 
when associated with stricture. 

J. O'B., the son of Jno. O'Brien, aged two years, residing 
in Jone's alley, Philadelphia, came under my care in 1842, as a 
dispensary patient, together with two other children in the 
same family, with measles. This child had sandy, curly hair, 
a freckled skin, and a large head. He was very much prostra- 
ted by the eruptive fever, and not expected to live during the 
whole of 48 hours of the disease. He gradually recovered, 
however, but was very irritable, appeared to suffer great pain 



104 THE HUMAN EAR. 

iu his head and left ear. In a few days, a slight discharge was 
observed from the meatus, for which nothing of importance 
was done. In three days more a great swelling was observed 
behind the ear, throwing the auricle forward, and making that 
side of the head appear much larger than the other. After 
the application of flaxseed poultices for two days, the abscess 
bursted over the mastoid process, and discharged a large 
amount of pus and some blood. 

As soon as this had taken place, the general health of the 
child appeared to improve very materially. He began to eat 
freely mashed potatoes, and to drink milk. Several fistulous 
openings were formed behind the auricle ; the bone was easily 
detected through each, on introducing a probe, and the general 
tumefaction and apparent misplacement of the auricle forwards, 
though less after the openings had formed, continued for seve- 
ral months. The child was placed under the use of compound 
syrup of sarsaparilla and iodide of potash. The ear was kept 
as clean as the habits of his parents would admit of, by syring- 
ing the meatus daily with tepid water. When the sores be- 
came large from excessive granulations, they were touched with 
the nitrate of silver, and the parts kept moderately clean. In 
the midst, however, of filth and dirt, the child, although he had 
lost the use of his lower extremities, from the debility induced 
by the fever, gradually gained strength, and at the end of six 
months was running about with the others most vigorously. 
He appeared even to retain some hearing in the diseased 
ear, the fistulae having entirely healed up, and the otorrhea 
having ceased. 



CHAPTER V. 

DISEASES OE THE INTERNAL EAR 

The diseases of the internal ear are necessarily obscure, 
and the symptoms indicative of special organic changes have 
not as yet as been clearly defined. We are therefore left to 
make the simplest division possible, namely, that based on 
functional derangement. In examing these cases, we must of 
course resort to every precaution to establish the negative fact, 
that there is no disease of the external or middle ear. 

The accurate and careful examination of the meatus, as well 
as a proper and thorough exploration of the Eustachian tube, 
are absolutely essential. 

The divisions I shall adopt, are as- follows : 

1. Eretheticor acute nervous deafness. 

2. Torpid, or chronic nervous deafness. 

3. Sympathetic nervous deafness, accompanied with acute 
pain in the nerves of the ear, not immediately acoustic. The 
ordinary name of which, is otalgia, or ear ache. 

1. The erethetic, or acute form of nervous deafness, may be 
distinguished by the following symptoms. 1. The degree of 
deafness, as indicated by placing a watch opposite the ear, will 
vary very much. In some cases, the ticking can be heard only 
when it is placed in contact with the auricle; in other cases, it 

(105) 



106 THE HUMAN EAR, 

may be heard from half an inch to ten inches from the head, 
in one ear, while with the other it cannot be heard at all. 
2. In these cases, the sound may be heard alicays, when the 
watch is placed between and held by the teeth. 3. The patient 
hears best in the midst of a noise. On board a rail-road car, 
even ordinary conversation will be distinctly heard and under- 
stood, while others cannot understand each other in conversa- 
tion. This a very striking symptom and should be carefully 
inquired into. In the vicinity of noisy machinery, in the 
midst of loud sounds, as those of drums, &c, the hearing is 
better. The noise of falling water, the rumbling of carts, or loud 
conversation by a number of persons, — in all these circum- 
stances, the function of hearing seems to be improved in ere- 
thetic nervous deafness. The reason of this appears to be, 
that the morbid impressions already existing in the nerves of 
audition are overcome by stronger ones; and the nerves thus 
placed in a better condition to act under the will, in receiving 
sounds, and the impressions from sounds from without. As in 
some forms of insanity, severe bodily pain so abstracts from 
the unhappy impressions of the mind, as to allow the individual 
to exercise his reason in a healthy manner. In the latter case, 
sudden danger, or any strong mental impression is some- 
times known to produce 'the same effect. 4. The patient 
experiences a great variety of abnormal sounds in his ears 
and head, especially at night. These have been compared 
to the ringing of bells, the sound of falling water, the hum- 
ming of bees, the simmering of a pot or kettle, the roaring of 
distant thunder, and sometimes to the explosions of guns or 
pistols. Generally the sounds are like the falling of water 
or the ringing of small bells. 

It is true, that these symptoms follow chronic closure of the 
Eustachian tube and thickening of the membrana tympani ; but 



DISEASES OF THE INTERNAL EAR. 107 

a careful examination of the case should be made before our 
diagnosis is made out. 

It must be remembered, however, that chronic closure of the 
Eustachian tube will be followed by a condition of the nerves 
of audition, such as have just been described, and we may have 
both conditions exist at the same time. So, also, of chronic 
thickening of the membrana tympani. 

1 knew an eminent and eloquent clergyman, who never 
heard his own voice, and could not, consequently, pitch it in 
the early part of his discourse. His wife was in the habit of 
telegraphing him on the subject, until he became warmed up, 
and then his voice assumed the full sound of former days, 
when he could hear it. This gentleman suffered immensely 
from deafening noises in his head at night. 

Treatment. — If there be any positive indications of the 
presence of inflammation in any part of the middle or internal 
ear, recourse must be had to antiphlogistics, such as leeches, 
blistering behind the ears, cathartics, low diet, &c, &c. Gene- 
rally, however, no such condition exists, and to resort to blisters 
and ear washes, whether stimulating or other, is merely to 
waste the time of the patient, or subject him to unnecessary 
pain and inconvenience. Having determined that the Eusta- 
chian tube is pervious, the external meatus and membrana 
tympani in a healthy condition, we must resort to remedies 
which will act as nearly as possible upon the parts affected. 

No general or constitutional remedies will avail, unless there 
be some derangement of the nervous system or digestive func- 
tions. A general nervous debility should be treated in the 
usual way, viz : tonics, iron, cold water, sponging, the flesh- 
brush, proper diet, &c, &c. 

Any biliary or gastric derangement that may be associated 
with the disease should of course be removed; and should 
habitual engorgement of the vessels of the brain co-exist, this 



108 THE HUMAN EAR. 

should, if possible, be removed. In other respects, the treat- 
ment is simple, and in many cases effectual ; in others, merely 
beneficial or palliative. 

The well known fact, that all forms of partial deafness tend to 
total deafness, should stimulate us to retard its progress, or 
if possible, stop this tendency, when we in any way can. To 
retain audition at two inches by the watch, will be much 
better than to lose it altogether ; and this in those cases may not 
unfrequently be done. 

The introduction to the tympanum of the vapor of ether, 
generally the sulphuric ether, either cold or warm, is considered 
the best treatment. Aqueous vapor, or that of ammonia diluted 
with aqueous vapor, introduced warm has been found beneficial. 
The vapor of alcohol has also been resorted to, and that of 
vinegar. 

The application of these vapors (the best of which is the 
sulphuric ethereal vapor) should be continued for weeks and 
months ; paying close attention at the same time to the condi- 
tion of the function of hearing ; keeping, in fact, a diary of 
the hearing distance of each sitting. 

A glass jar, with a cork in the mouth of it, in which two 
holes have been bored, and into one of which the gum elastic 
tube, or gum shelac tube has been introduced, may be prepared. 
The second hole in the cork is to be used to pour in a few drops 
of ether, and then to be covered by a piece of wood. The pa- 
tient is to sit on a chair with one elbow (that corresponding to 
the ear affected) on the table on which the jar is placed; the 
end of the tube is to be adjusted to the catheter, already intro- 
duced to the mouth of the Eustachian tube. He may with one 
hand support the catheter and tube, and with the other pour 
a little ether into the jar. He should sit from fifteen to twenty 
minutes each time. The ether will rise and fill the jar and 
Dass along the tube and catheter into the tympanum communi- 



DISEASES OF THE INTERNAL EAR. 



109 



eating a sensation of warmth, and sometimes a soothing anodyne 
sensation. 

The hearing distance in favorable cases will, at the end of 
each sitting, be sensibly improved. This should be done daily, 
or every other day, carefully watching the effects of the appli- 
cation. It will be found that damp weather will materially 
influence the function of hearing, particularly if it be also 
cold, or the patient contract a cold, or suffer from any ma- 
terial functional derangement of his organs of organic life. 



Fig. 9. 




The air-press may sometimes be substituted for the ether 
jar, or the latter may be heated by means of an iron ring 
passed over it after being heated in the fire : or the jar may be 

10 



110 TIIE HUMAN EAR. 

placed in warm water to induce the more rapid evaporation of 
the ether. The author has seen many cases in which this 
treatment has very much relieved the patient's disease, and 
others, where it has diminished the deafness, and produced a 
stationary condition of the disease. 

Another mode of using the ether, and one. which I have 
found in several cases very useful, is to inhale the 'ether through 
the nostrils or mouth, until the throat is full of it, then close 
the mouth and nostrils and attempt its expulsion by forcible 
exhalation. This method drives the vapor into the tympanum, 
and is indeed the only way, in some patients, in which we can 
induce them to use the ether. 

" Of all kinds of ethers (says Kramer,) the preference is beyond 
question due to acetous ether, on account of its extreme mild- 
ness. Sulphuric ether, ammonia, (especially in conjunction 
with camphor,) etherous oils, tincture of coffee, and the like, 
have always over excited the auditory nerve, even in my most 
careful trials of them." Each sitting in the use of the ether 
should occupy about fifteen or twenty minutes daily ; and the 
catheter should be introduced, on alternate days, to the right 
and left ears, when both are treated ; when but one is treated, 
the application should also be daily. The following case 
will illustrate the treatment in this form of nervous deafness, 
and is taken from among others in my note-book. 

Miss S-., aged eighteen years, daughter of a distinguished 
judge of the State of New York, was placed under my care in 
May of the year 1844. She was embonpoint, with very fair 
skin, and auburn or very light brown hair. She had gradu- 
ally become more deaf for four years : and was now under 
the necessity of being close to a person addressing her, and of 
observing the features during conversation. 

On the 4th of May, the hearing distance, as indicated by 
my watch, after the application of the air-douche in the 



DISEASES OF THE INTERNAL EAR. Ill 

right ear, was four and a half inches, and in the left, pre- 
vious to the use of the air-douche, about twelve inches. The 
air from the air chamber was distinctly felt by the patient to 
rush with " a crackling noise" into the tympanum. A slight 
uneasiness followed. 

The mucous membrane of the throat and fauces was tumified 
and puffy, and the tonsils considerably enlarged. A considera- 
ble discharge of thick tenacious mucous took place from the 
fauces and throat. The Schneiderian membrane was very red, 
and bled very easily on touchicg it with the catheter. The 
latter instrument could be introduced, with care, to the Eusta- 
chian tube of the right ear, but not to that of the left, on 
account of the irritation produced in the throat. 

She was directed to abstain from the use of coffee ; to 
drink but little fluids of any kind ; and to live on dry, chiefly 
vegetable food. The throat to be washed evening and morning 
with cold water, and rubbed off with a dry coarse towel. Early 
rising was recommended, and plenty of out-door air and 
exercise. 

The following prescription was directed to be taken in table- 
spoonful doses, twice a day, in a wine glass- full of water. 

R. Syr. sarsa. com. fgiv. 
Potass, iodid. gii. 

To gargle the throat freely, and often, with cold water. 

On the 9th, the hearing distance of the right ear had in- 
creased four inches; and the left was still irritable, but relieved 
of much of the ' roaring' noise habitually in it, by the use of 
the air-douche. 

11th. Considerable pain and noise have been experienced in 
the left ear ) for which a mustard poultice is directed behind 



112 THE HUMAN EAR. 

the auricle ; and for a slight discharge from the meatus, six 
grains of acetate of lead, in two ounces of distilled water, 
were directed, with which to inject the meatus. 

An astringent gargle of alum, honey, and sage tea, was 
also directed to be used. On the 13th, the hearing distance of 
the right ear had attained thirteen inches. 

14th. The hearing distance of the right ear, in a quiet room, 
is sixteen inches, and that of the left, a full arm's length 
and more. The irritation of the left Eustachian tube is subsi- 
ding ; the passage being quite pervious to air and vapor. 

15th. The hearing distance of the right ear, twenty-four 
inches; that of the left, as before. 

16th. She experiences the sensation of a watch ticking in 
the ear. Confounds this with the real sound, and thinks the 
hearing the same as when first examined. 

17th. Hearing the same. Air-douche, ether and cold water. 

20th. Hearing distance ten inches in right ear, twenty-four 
in the left. 

22d. Hearing distance continues to improve. 

On the 25th, inflammation attacked the left meatus, and a 
blister was directed to be placed behind the ear. The falling 
back so suddenly was due, evidently, to a cold, caught from 
exposure to a storm in a country excursion, with some young 
friends. There is a strong tendency, however, to inflammation 
both in the mucous surfaces of the throat and tympanum, as 
well as in the lining membrane of the meatus of each ear. As 
this inflammation subsided the function of hearing rapidly im- 
proved, until the 29th and 30th, when she caught another cold, 
and on the 31st, the hearing distance had returned almost to 
the original condition in the right ear. Appropriate reme- 
dies were used for the i cold/ and, on the 4th of June, the left 
ear had gained four inches again. The application of the ether 
to the right ear, and of the air-douche to the left, was continued 



DISEASES OF THE INTERNAL EAR. 113 

'up to the 12th ; when the ether was applied alternately to 
each ear. 

This treatment was continued to the 26th of June, when 
circumstances made it necessary for her to return home, with 
the promise to return in the autumn. The hearing distance 
was then about three times the extent it was at the beginning 
of the treatment, in the right ear ; and about twice the dis- 
tance in the left ear. My note book says, " she commenced on 
the 6th of May, with roaring in her ears ; since that she has 
experienced ticking and other sounds, but she now has no 
sounds whatever, and expresses herself as having more con- 
sciousness in her ears." 

I have frequently seen this lady since that time ; and although 
she has since been married, and did not " return in October/' 
yet the improvement continues to the present time. She can 
hold a conversation across a room without difficulty in an ordi- 
nary tone. 

This was a strumous case, and liable frequently to mucous 
engorgement of the Eustachian tube on the occurrence of slight 
changes in the weather, particularly if they were from a dry to 
a wet or damp condition. The air-douche with astringent 
gargles, or the nitrate of silver, applied in solution to the 
throat, were the appropriate remedies. One great thing gained 
is the stationary character which these cases assume, after well 
marked improvement. If nothing more than this was gained, 
it would be worth the trouble to resort to the treatment above 
detailed. 

2. Torpid Nervous Deafness. — This is distinguished from 
the last form of the disease, by the absence of any kind of 
noise in the ears, and by a more complete loss of the function 
of hearing. 

The treatment is the same, when any is resorted to, except 
that it should be a little stronger. The ether should be heated 

10* 



114 THE HUMAN EAR. 

or driven in with more force, or the vapor of ammonia, or 
alcohol, or even water itself, may be used. The writer has 
often used the latter article to inject the tympanum, and 
found that water does not irritate the parts much ; especially 
when tepid. 

Torpid nervous deafness, is the deafness of old age, or of 
any other cause which destroys the function of the seventh 
pair of nerves. Very little or no good can be expected to re- 
sult from stimulating a nerve so altered as to receive no im- 
pression from the ordinary media of audition. At the same 
time it must not be forgotten, that deafness is by no means a 
necessary concomitant of increasing years ; but that frequently, 
the gradual or sudden deafness of old persons is entirely due 
to one or more of the causes enumerated under the head of 
cophosis. The writer is disposed to believe that many old 
people gradually lose their hearing from neglect, and want of 
proper attention to the conditions of the external meatus and 
tympanum. As a general rule, we should treat diseases of the 
ear in old persons precisely in the same way as we do those of 
the young. 

When, however, either an old or a young person becomes so 
deaf as to be unable to hear ordinary conversation, and no 
relief is to be expected from any remedial measures, some 
means must be resorted to, to place him in communication 
with those around him. 

The ordinary practice of placing the hollow of the hand 
behind the auricle, in order to increase the number and force 
of the vibrations, has doubtless suggested the use of an en- 
larged auricle or trumpet. This is placed on the ear and a 
tube from it enters the meatus, and should be long and large 
enough to straighten and enlarge the latter ; with this simple 
contrivance many deaf persons are enabled to hear sermons 
and other public addresses with comparative ease. 



DISEASES OE THE INTERNAL EAR. 



115 



For private conversation, which is so unpleasant to many 
deaf persons, (on account of the unnatural screaming which 
some resort to, — in that way producing a very painful im- 
pression on the ear,) the best instrument by far that the author 
is acquainted with, is a gum elastic tube, similar to the otoscope 
used in England. 

This tube has a bent horn, or ivory pipe, at one end, of the 
size of the external meatus, into which it is inserted. The 
other end terminates in a trumpet-shaped expansion, made also 
of horn, or ivory. The whole tube is about eighteen or twenty 
inches long, and may be easily carried in the pocket. Conver- 
sation may be held with this, with a deaf person, while walking 
along the street. {See cut, fig. 10.) 

Kg. 10. 




Some curious facts have been observed in reference to deaf 
persons, who have, by the use of a solid, particularly a metallic 
body, placed in contact with a post or pillar, in a room filled 



H6 THE HUMAN EAR. 

with persons in conversation, been able to follow the course of 
an argument held in their vicinity, when not at all suspected of 
hearing any thing by those listened to. The writer knows a 
gentleman who often surprises his friends in this way; who says 
he does it by close attention to the sounds transmitted through 
the pillar, key, eye-tooth and bones of the head; and by watch- 
ing the countenances of the interlocutors. 

It should always be remembered by those who converse with 
deaf persons, that raising the pitch of the voice, so far from 
making them hear, absolutely prevents it. We know an old 
lady who is very deaf, who says to those addressing her in this 
way, " do not speak so loud, or I cannot hear a word ; speak 
low and distinctly, then I can hear." 

3. Sympathetic Nervous Deafness. — Our present ideas of the 
functions of the nerves of special sense, do not permit us to 
suppose that they are subject to neuralgia, in the ordinary ac- 
ceptation of the term. Certainly not the nerves of audition, 
vision and olfaction. This, however, does not preclude the 
possibility of a neuralgia of those nerves which are accessary 
to the function of hearing. The otic ganglion, the plexus 
around the membrana tympani, corda tympani, one or all, may 
be the seat of pain. Are not many of the cases of paroxys- 
mal ear-ache to be referred to these nerves, and to a condition 
of them, analagous, if not idenical with that of tic doloreux ? 
Have not writers and teachers been lately disposed to pass by 
these conditions of the nervous fibres connected with the organs 
of audition, in their anxiety to establish pathological conditions 
of the other tissues? "We believe they have, and while a sim- 
plification of all aural affections into otalgias and otorrhea, as 
was formerly the case, is to be deprecated ; the total disregard 
of otalgia, as such, is equally wrong. The disease may be 
detected by close examination of the ear, and attention to the 
symptoms. The absence of positive symptoms in the outer 



DISEASES OF THE INTERNAL EAR. 117 

and middle ear, the acuteness of the pain, absence of hearing, 
and especially a disposition to periodicity, will lead the careful 
surgeon to the conclusion, that the disease is nervous. 

Care should be taken to detect the cause : to see whether it 
be associated with rheumatism, or be the chief symptom of a 
paroxysm of intermittent fever, or be connected with secondary 
syphilis, or some organic irritation transmitted by sympathy to 
the nerves of the ear : as a diseased tooth or teeth, inflamed 
throat, or tonsils, or both. A draught of cold air, cold feet, 
or foreign bodies in the meatus, are also causes. 

Treatment. — Where a rheumatic condition of the system 
exists, the disease will be relieved or cured by combining 
preparations of colchicum, guaiacum, or other anti-rheumatic 
remedies., with those calculated to relieve neuralgia. The 
writer has relieved simple neuralgic cases very quickly, by 
placing a few drops of chloroform on some cotton or wool, and 
inserting it in the meatus. Anodyne drops, such as an aqueous 
solution of opium, sulphate of morphia, or arnica, will be found 
beneficial in these cases. Great care should be taken not to 
introduce alcohol, or other stimulating fluids into the meatus. 
In malarious districts, the intermittent form of the disease is 
not uncommon ; and should be met with quinine, and other 
anti-periodic remedies. 

Pure tic doloreux of the ear should be treated with carbon- 
ate of iron, combined with quassia, ginger, and other vegetable 
tonics and stimulants. 

When associated with tertiary syphilis, the various pre- 
parations of iodine will be found beneficial and necessary. 
Anodyne poultices, and fomentations of hops, arnica, opium, 
or other narcotics will be found very useful. Care being 
taken to protect the parts from atmospheric changes of tem- 
perature. 



118 THE HUMAN EAR. 

We cannot conclude this chapter, without warning the junior 
practitioner against confounding this disease with acute inflam- 
mation of the membrana tyinpani, or external meatus, known 
under the title of ear-ache. A simple examination of these 
parts with the speculum will decide the question, and affect 
very much the treatment. 



CHAPTEE VI. 



DEAF MUTES. 



It is a pretty well known fact, that children who lose their 
hearing previous to the seventh year of their age, or even later, 
lose also the faculty of speech. Indeed any considerable loss 
of the function of hearing, making it difficult and troublesome 
for a child to catch and understand individual words in ordi- 
nary conversation, will induce him to neglect gradually the use 
of the function, and resort to signs as a means of communication. 
Should any defect in the structure of the ear exist at birth, 
sufficient to destroy hearing, the individual is, of necessity, 
dumb. Speech will never be acquired. 

Professor Hamilton, of Buffalo, reports one case of dumb- 
ness without deafness ; but this condition of things very seldom 
exists, and depends, probably, on some defect, either in the 
larynx or cerebrum. 

For the relief of persons so unfortunate as to be deaf and 
dumb, several noble institutions have been established in the 
United States. That established in Philadelphia has been in 
operation for many years, (since 1820,) and numbers about 
one hundred and thirty-four pupils — seventy-two of whom are 
males, and sixty-two females. 

(119) 



* 






120 THE HUMAN EAR. 

These come from the States of Maryland, Delaware, Pennsyl- 
vania and New Jersey. 

In a table of the forty pupils admitted during the year 1850, 
29 were born deaf. 

lost hearing, by disease, at 8 years of age. 
" measles, at 4 " 

whooping cough, 2 years of age. 
inflammation of ears, at 6 months, 
typhus fever, at 1 year and 6 months. 
" scarlet fever, between 4 and 5 years. 

" " 4 and 5 months. 

" " 3 and 4 months. 

u " 5 years old. 

" u 1 yr. and 8 months. 

" " 3yrs.and6 " 

u " 7 years old. 

" " 1 year old. 

" * 8 years old. 

It will be seen by the above table that more than half of the 
cases were those of congenital deaf-dumbness. The question 
of hereditary transmission has not yet been fairly investigated ; 
but it is now well understood that the marriage of cousins, and 
other near relatives, is decidedly favorable to the development 
of these and other imperfections. The principals of these in- 
stitutions, in New York and the Eastern States, are now well 
acquainted with the fact, that not only defects in the organs of 
hearing, but in the brain, producing idiocy, epilepsy, and in- 
sanity, are the direct results of such marriages. 

The deaf do not, necessarily, transmit deaf offspring ; on the 
contrary, the reverse is the most common. 

It will be seen by the above table, that the period within 
which deaf-dumbness occurs is limited to the first eight years 



DEAF MUTES. 121 

of life; and that, generally, the diseases of infancy destroy 
hearing between the second and sixth year. 

The instruction of these unfortunate individuals is a very 
important feature in the philanthropic operations of the present 
day. Many things may be communicated to and from them by 
the ordinary natural or instinctive signs made by the body; 
il and it is very important to the deaf mute, that his parents and 
friends should cultivate the language of signs, and encourage 
him in the use of them as early as possible. 

" Let them observe the child, and imitate the signs he makes. 
When he is pleased with anything, invent a sign for the thing, 
and repeat that sign many times afterwards. Distinguish dif- 
ferent persons by signs, suggested by a scar, mole, beard, or 
any little peculiarity which the person may possess. 

" Imitate the actions of riding, sewing, eating, mowing, 
cutting, throwing, sowing, &c. 

"For 'good/ kiss the hand. For 'bad/ bring the hand to 
the lips, turn the palm down and throw it from you. For 
'glad/ pat the heart rapidly, with a cheerful expression of 
countenance, For ' sorry/ rub the clenched hand on the heart, 
with a sad expression of countenance. 

" For ' black/ draw the end of the forefinger along the eyebrow. 

"For 'red/ touch the lips with the forefinger. For 'love/ 
cross the hands and press them on the heart/ For ' hate/ push 
both hands, the palms out, from the heart, as if repelling 
something from the left side. For ' lie/ move the forefinger 
across the mouth horizontally. For ' true/ place the forefinger 
perpendicularly across the lips and thrust it forwards." 



11 



CHAPTER VII. 



CONCLUSION. 



It is not the province of the aural surgeon to speak of the 
instruction of deaf-mutes : yet every physician and the citizens 
generally, should be acquainted with the best mode of inducting 
the unfortunate individuals in the language of signs. The 
present attempt to introduce a work written by an American 
author, and embodying the opinions and practice of American 
surgeons on aural surgery, will, it is hoped, meet that indulgence 
which a first attempt generally demands. That the diseases of 
the ear are very much neglected, in our country, a practice of 
some twenty years has fully proved to us. An attempt has been 
made to supply the necessary literature by the republication of 
foreign works, — many of which are voluminous, verbose, and 
expensive : and, if we are to believe their fellow writers, not at 
all to be relied upon. The authorities quoted in this work are 
personal experience, and that of American surgeons, as far as 
practicable, and it could be obtained. It is very evident, however, 
that the whole subject is more or less underrated by some who 
write books. The following wise sentence, taken from a very 
recent work which pretends to present American operations and 
authors, will afford its readers with but a poor idea of the writer's 
opinion or knowledge of the number and value of operations 
(122) 



CONCLUSION. 



123 



upon the ear : " Washing out the external and internal audi- 
tory tubes, with perforation of the membrana tyinpani, or per- 
haps the mastoid cells, really constitutes the entire portion of 
aural operative surgery, and are certainly easily executed."* 
This is the work that the learned publishers informed the 
author, would entirely supersede his little book, and make its 
publication quite unnecessary ! ! ! 

The air-press which the author has been in the habit of using, 
is a simple tin chamber, (3,) supplied with an air-tight stop-cock, 
to which, after the chamber has been filled with air by means of 
the forcing pump, (1,) is attached a pipe with a brass nozzle. The 
other extremity of the flexible pipe, fits by means of another 
brass nozzle, (2,) into the external opening of the catheter of the 
Eustachian tube. 

Fig. 10. 




We think it well to add also a cut of the catheter usually 
known as Kramer's. It is about five inches long, and divided 
and marked by inches. Many operators who have followed the 
directions of this author, prefer his catheter. 



: Smith's Operative Surgery, Part I, p. 219. 



124 THE HUMAN EAR. 

Pig. 11. 





B 


-■■-—■ ■■-■ 


:""• .'-:.; 


BBHHHHBSS 






Hfl 


— ; -. _ 








~ 



We have only to say, in conclusion, that many more cases 
of the various diseases might have been added under their 
several heads; but, in our opinion, this would but add 
to the size and expense of the book, without improving it in 
proportion. 

Several cases are under treatment at this moment, of nervous 
deafness: diseases and loss of the membrana tympani, and 
otorrhea. 

The author would be happy to receive any communications 
from his former pupils, those of Geneva, Castleton, and the 
Philadelphia Colleges of Medicine, or from other members of 
the profession, containing instructive cases, or well made post 
mortem examinations. 



THE END. 



